Internship Program

WELCOMEThank you for applying for the FFC Internship Program starting August 15, 2016! In order for us to start processing your application, we must receive ALL the following completed forms and application fees. If a question does not apply to you, please write N/A in the blank. This program is designed for High School graduates or those 18 to 25 years old. Filling out this application does not guarantee acceptance into the program. There will be follow-up interviews and prayer over each applicant.God bless you as you seek His guidance in this process. CHECK LIST:

MAIN APPLICATION FORM☐Please fill out the five or six (5or 6) pages of the main application form.Attach a recent photo. Preferably a 2 x 2 ‘Passport’ type from shoulders and up.

APPLICATION FEE☐A non-refundable application fee of US $25 for singles and US $45 for couples is to be sent in with your application. Fees must be paid in US dollars ONLY. For checks, please make it payable to “Faith Family Church.”

PERSONAL HISTORY☐Please prayerfully answer the following questions on a separate sheet of paper and attach to the application form. Your answers will be significant in the application process. Please write or type no more than 2 pages total.a) How long have you been a Christian? Describe your conversion experience.b) Describe your present relationship with the Lord and the areas you are seeking to develop in your

character.c) Describe your spiritual and ministry goals.d) Describe your relationship with your local church and areas of ministry within it. e) Describe your business, professional, or missions experiences.f) What influenced you to apply for the FFC Internship Program.g) Describe your relationship with your family and their feelings about your training at FFC.

HEALTH FORMS☐Please complete all questions on the health form. Fill out the “Health Form A: Personal History” about yourself, and bring the Form A & B to your physician and have them fill out the “Health Form B: Physician’s Evaluation”.

☐ REFERENCE FORMS

Internship Program

You need to have three “Reference Forms” completed from... 1) Employer or teacher, and 2) a Friend, and 3) your Pastor or Ministry Leader. Provide a stamped envelope to the below address for the person filling out this form. After you give the form (2 pages each) to your reference persons you should not handle or process the form again.Faith Family Church 2002 E Mockingbird Ln. Victoria, TX 77904 Attn: Internship Program

Application Date (day/mo/yr): ________________________________________________________Program Starting Date (mo/yr): ______________________________________________________________________Application fee enclosed? ☐ $25/single ☐ $45/couple

PERSONAL INFORMATIONFirst Name: ______________________________________________ Gender: ☐ M ☐ FMiddle Name: ____________________________________________ Phone (home): ___________________________________________Last Name: ______________________________________________ Phone (cell): _____________________________________________Preferred Name: _________________________________________ Phone (other): ___________________________________________DOB (day/mo/yr): ________________________________ Age: __ Fax : _____________________________________________________Birth Place (city, state/province, country)_____________________________________________________________________________U.S. Driver’s License #: ____________________________________________Email address (primary): ___________________________________________

Current Address: ___________________________________________________________________________________________________City: _____________________________________________________ State/Province: ____________________________________________Postal/Zip Code: __________________________________________ Country: ___________________________________________________Permanent Address (if different): __________________________________________________________________________________City: _____________________________________________________ State/Province: ____________________________________________Postal/Zip Code: __________________________________________ Country: ___________________________________________________

FAMILY INFORMATIONMarital Status:____________________________________________☐ Single ☐ Engaged (Date __________________)

☐ Married (Date__________________) ☐ Separated (Date __________________) ☐ Divorced (Date ___________________)

☐ Remarried (Date ___________________) ☐ Widowed (Date ___________________)

If married, give spouse’s information:First Name: ______________________________________________ DOB (day/mo/yr): ________________________________________Middle Name: ____________________________________________ Birth Place: ______________________________________________

PLEASE ATTACH

RECENT PHOTO

HERE

Internship Program

Last/Family Name: _______________________________________ Wedding Anniversary (day/mo/yr): _______________________

Internship ProgramEMERGENCY CONTACTS

Full Name (contact #1): _________________________________________ Relationship: ___________________________________Address: _____________________________________________________________________________________________________________City: _____________________________________________________ State/Province: ___________________________________________Zip Code: ________________________________________________ Country: _________________________________________________Phone Number: __________________________________________ Email: ____________________________________________________

Full Name (contact #2): _________________________________________ Relationship: ___________________________________Address: _____________________________________________________________________________________________________________City: _____________________________________________________ State/Province: ___________________________________________Zip Code: ________________________________________________ Country: _________________________________________________Phone Number: __________________________________________ Email: ____________________________________________________

CHURCH BACKGROUNDChurch Name: ____________________________________________ Denomination/Affiliation: _________________________________Pastor’s Name: ___________________________________________ Phone Number: __________________________________________Address: _____________________________________________________ City: ______________________________ State/Province: _Zip Code: ________________________________________________ Country: _________________________________________________Email: ____________________________________________________ Fax Number: _____________________________________________How long have you been attending? _____________________________________________

EDUCATIONAL DEGREES☐ I have a GED. ☐ I have not completed high school/secondary school. My highest educational level completed is: ______________________High School/Secondary School/College/University/Seminary Attended:Institution: City: _____________________________________________________Dates Attended: ____________________________ Major: _________________________________ Degree Graduated With: _________Institution: City: _____________________________________________________Dates Attended: ____________________________ Major: _________________________________ Degree Graduated With: _________Institution: City: _____________________________________________________Dates Attended: ____________________________ Major: _________________________________ Degree Graduated With: _________

VOCATIONAL EXPERIENCE, GIFTINGS, SKILLS, & INTERESTSCurrent Employment: ____________________________________ Dates: ___________________________________________________Brief job Description: _________________________________________________________________________________________________Previous Employment: ___________________________________ Dates: ___________________________________________________Brief job Description: _________________________________________________________________________________________________

Internship Program

Previous Employment: ___________________________________ Dates: ___________________________________________________Brief job Description: _________________________________________________________________________________________________

Skill Experience Levels (Leave blank if you have no experience): 1. Little 2. Some 3. Considerable 4. Extensive 5. Professional _________Cooking _________Cleaning _________Desktop Publishing____________________Computer Programming_________Clerical Work _________Child Care _________Auto Repair _________Electrical_________Baking _________Accounting _________Heating Repair _________Painting_________Receptionist _________Sound Equipment _________Carpentry _________Plumbing_________IT Skills _________Graphics _________Landscaping _________Heavy Equipment Other skills & abilities not listed above _______________________________________________________________________________

PREDOMINANT ETHNIC BACKGROUNDPlease specify ethnic background: ____________________________________________________________________________________

LANGUAGES: English Proficiency (please circle)1. Elementary Speaking 2. Limited Word Proficiency_3. Minimum Professional Proficiency4. Full Professional Proficiency__________________________5. Native Speaking Proficiency____________6. Mother Tongue

Other Languages and Proficiency: ____________________________________________________________________________________

PASSPORT / VISANOTE: You need to have a passport that will be valid for 1 year minimum from the program starting date.Name as Listed on Passport:__________________________________________________________________________________________Citizenship: __________________________________ Birth Place (City, Country): ___________________________________________Passport Number: __________________________________________________ Issue Date: _____________________________________Issue Place (City, Country): _________________________________________ Expiry Date: ____________________________________Do you have multi-citizenships? ☐ Yes ☐ No If yes, please give the same information on other than the one above on a separate paper and attach it.☐ I do not have a valid passport as required, but (circle one) applied / will apply for it on (day/mo/yr): ______________

CONSENT FOR TREATMENTI/We hereby agree to the performance of such treatment, anesthetics and procedures as deemed necessary in the opinion of attending physicians.Printed Name: ________________________________________________________________________________________________________Applicant’s Signature:____________________________________ Date:_____________________________________________________Signature of parent or guardian required if applicant is under 18 years of age.Parent/Guardian Signature: ______________________________ Date: ____________________________________________________

Internship ProgramRELEASE OF LIABILITY

I/We do hereby release Faith Family Church, the Internship Program, its staff, agents and volunteer assistants from any liability whatsoever arising out of any injury, damage or loss which may be sustained by said person(s) during the course of involvement with the program.Printed Name: ________________________________________________________________________________________________________Applicant’s Signature:____________________________________ Date:_____________________________________________________Signature of parent or guardian required if applicant is under 18 years of age.Parent/Guardian Signature: ______________________________ Date: ____________________________________________________

PHOTO RELEASEI , the undersigned, hereby give permission to Faith Family Church to use my name and photographic likeness taken, while participating in any school or community activity, in all forms of media for advertising, trade, and any other lawful purpose. Printed Name: ________________________________________________________________________________________________________Signature: ________________________________________________ Date: ____________________________________________________Signature of parent or guardian required if applicant is under 18 years of age: Parent/Guardian Signature: ______________________________ Relationship: _________________________ Date: _____________

FINANCIAL INFORMATIONDo you have your complete program fees? ☐ Yes ☐ NoIf No, how much do you have at this time? $______________ From what source will they come? ________________________Do you have any outstanding debt? If so, please explain: _____________________________________________________________

ACKNOWLEDGEMENT OF FINANCIAL RESPONSIBILITYI understand that payments of the required internship tuition fees must be made in U.S. currency prior to or upon my acceptance. Further, I agree to meet in a timely manner, prior to the completion of school, all personal expenses incurred during my involvement with the FFC Internship Program. I will abide by the spirit, rules and schedule of the church and program. Printed Name: ________________________________________________________________________________________________________Signature: ________________________________________________ Date: ____________________________________________________Signature of parent or guardian required if applicant is under 18 years of age: Parent/Guardian Signature: ______________________________ Relationship: _________________________ Date: _____________

TUITION & MISSIONS TRIP REFUND POLICYProgram Refund Policy - Should you have to leave the program early for some unforeseen reason; the following refund policy will determine the amount of money that will be refunded to you. The application fee is not part of the refundable amount.Week 1: you will receive 92% of your tuition Week 2: you will receive 84% of your tuition Week 3: you will receive 76% of your tuition

Week 4: you will receive 66% of your tuition Week 5: you will receive 58% of your tuition Week 6: you will receive 50% of your tuition

NOTE: There will be no refund to you after week 6 in the event that you must leave the program early. Missions Trip Refund Policy

Internship Program

Before the Missions Trip; funds that you have paid in toward outreach that can be refunded to you will be. However, if airline tickets/visas have already been purchased and for some reason cannot be refunded in whole by the agency of purchase, you will only be refunded the money that the purchasing agent will refund. If any funds have been raised on your behalf and you end up not going on the Missions Trip you release those funds to be used where/as needed for the Missions Trip. (Please let this be known to those that give to you for this trip.)If you are on the Missions Trip and have to return home for an emergency, you will be refunded any housing or food money that you have already paid in and will not use. Airline tickets will not be refunded at this point. You will be responsible for any additional costs to fly you home early. I have read the above Program and Missions Trip Refund Policy and agree to its provisions. Should it become necessary to leave the program or Missions Trip early for any reason, I agree to the refund amount stated in the above policy of FFC INTERNSHIP. I certify that all information in this application is complete and accurate.Applicant’s Signature: ____________________________________ Date: ____________________________________________________Signature of parent or guardian required if applicant is under 18 years of age: Parent/Guardian Signature: ______________________________ Relationship: _________________________ Date: ____________

CONFIDENTIAL HEALTH FORM A: PERSONAL HISTORYTO THE APPLICANT: This information is treated as confidential. Please print or type answers to ALL questions in English. Although your responses to these questions will not necessarily affect acceptance considerations, as certain medical conditions may preclude acceptance, Form B must be completed by your physician or physician’s assistant. FFC INTERNSHIP PROGRAM: STARTING DATE: August 15, 2016First Name: ______________________________________________ DOB: _____________________________________________________Middle Name: ____________________________________________ Birth Place: ______________________________________________Last/Family Name: _______________________________________ Please rate your health: ☐ Excellent ☐ Good ☐ Fair ☐ PoorDo you have medical insurance? ☐ Yes ☐ NO If Yes, Name of Insurer: _________________________________________Insurance #: _____________________________________________ Insurer Phone: ___________________________________________Type of Coverage (briefly): ___________________________________________________________________________________________Please answer all questions and take both Form A and Form B to your physician. Comment on all “yes” answers on a separate sheet of paper. The omission of health history problems or incomplete explanation of the same can lead to removal of acceptance status. Have you ever had, or do you now have, any of the following?

NO YESRecurrent Headaches ☐ ☐Hepatitis ☐ ☐Jaundice ☐ ☐Recurrent Diarrhea ☐ ☐Intestinal Troubles ☐ ☐Kidney Disease ☐ ☐Diabetes ☐ ☐Venereal Disease ☐ ☐Anemia ☐ ☐High Blood Pressure ☐ ☐Heart Trouble ☐ ☐Allergy: Serum ☐ ☐Rheumatism/Arthritis ☐ ☐Paralysis ☐ ☐Back Problems ☐ ☐Insomnia ☐ ☐Dislocation of Joints ☐ ☐Shortness of Breath ☐ ☐Allergy: Food (specify) ☐ ☐

NO YESFainting Spells ☐ ☐Tumor/Cancer ☐ ☐Weakness ☐ ☐Skin Condition ☐ ☐Low Blood pressure ☐ ☐Eye Trouble ☐ ☐Allergy: Bee Stings ☐ ☐Ear Trouble ☐ ☐Allergy: Penicillin ☐ ☐Head Injury ☐ ☐Allergy: Sulfonamides ☐ ☐Mental/Nervous Disorders ☐__☐Asthma ☐ ☐Gall Bladder Problems ☐ ☐Epilepsy ☐ ☐Hay Fever ☐ ☐Stomach/Duodenal Ulcer ☐__☐Broken Bones ☐ ☐Surgeries ☐ ☐

COMMUNICABLE DISEASES:Have you ever had any of the following?

NO YESChicken Pox ☐ ☐Measles (Rubella) ☐ ☐Measles (Rubeola) ☐ ☐Mumps ☐ ☐Pertussis ☐ ☐Scarlet Fever ☐ ☐Tuberculosis ☐ ☐OTHER (specify) __________________FEMALES ONLY:Do you currently have any of the following?

NO YESIrregular Periods ☐ ☐Severe Cramps ☐ ☐Excessive Flow ☐ ☐Are you pregnant? ☐ ☐ due date ______________________

Please explain any other illnesses, conditions, or surgeries you have had or are going through currently: ____________________________________________________________________________________________________________________________________Are you presently under a doctor’s care for any condition? ☐ No ☐ Yes Specify: _________________________________Are you presently taking any medication? ☐ No ☐ Yes Specify: __________________________________________________Are you allergic to any medication/drugs? ☐ No ☐ Yes Specify: _________________________________________________Do you have a history of emotional instability or psychiatric treatment? ☐ No ☐ YesIf “Yes”, when: __________________________________ For how long: _________________________________ Still in treatment? ☐ No ☐ Yes Please explain: _______________________________________________________________________________________________________Do you have any history with: Eating disorders: ☐ No ☐ Yes ; Drug or alcohol abuse: ☐ No ☐ Yes ; Sexual issues: ☐ No ☐ Yes If “Yes” to any above, when: ____________________________ For how long: _____________________________ Currently? ☐ No ☐ Yes Please explain: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________Do you have any physical impairments, handicaps, or health conditions which require special attention? ☐ No ☐ Yes Specify: _____________________________________________________________________________________________________________________________________________________________________

Have you been tested for HIV/AIDS? ☐ No ☐ Yes Have you been diagnosed as having HIV/AIDS? ☐ No ☐ Yes

Internship ProgramCONFIDENTIAL HEALTH FORM B: PHYSICIAN’S EVALUATION

Applicant’s Name: ________________________________________ Date of Application: ______________________________________

TO THE PHYSICIAN: Please review the information in Form A. Please treat all conditions that you feel require treatment and notify us of any problems that you feel merit follow-up by the health service. Some conditions such as diabetes, epilepsy and heart disease may have an effect on the location of the applicant’s Missions Trip. Please ensure that any pertinent information in these areas has been included.Are all necessary immunizations up to date? ☐ No ☐ Yes Which are needed? __________________________________________________________________________________________________________________________________________________________________________☐ Chest X-ray__________Date: ______________ Result: ____________ Examination Facility: ___________________________________☐ TB Test Type:________ Date: __________ Result: ____________________ Examination Facility: _____________________________Height: ___________/____________ Weight: _____________________ Pressure: _____________________________ Pulse: ______________________ Blood Type: _____________________________________

Are there any abnormalities of the following systems? Please describe fully.E. N. T. _______________________________________________________________________________________________________________Ophthalmological ____________________________________________________________________________________________________Teeth ________________________________________________________________________________________________________________Neurological _________________________________________________________________________________________________________Cardiovascular _______________________________________________________________________________________________________Respiratory __________________________________________________________________________________________________________Musculoskeletal ______________________________________________________________________________________________________Endocrine ____________________________________________________________________________________________________________Lymphatic ___________________________________________________________________________________________________________Dermatological _______________________________________________________________________________________________________Hernial Orifices ______________________________________________________________________________________________________Urological ____________________________________________________________________________________________________________Psychiatric ___________________________________________________________________________________________________________Recommendations For Follow-up Tests / Treatment: __________________________________________________________________Would he/she be able to walk 3 – 4 miles per day? ☐ No ☐ Yes

PHYSICIAN’S RECOMMENDATION:☐ Acceptable Without Limitations ☐ Not Acceptable ☐ Should Remain In Areas Where Adequate Medical Care Is Provided ☐ Acceptable With Limitations (specify) _____________________________________________________________________________Additional Comments: _______________________________________________________________________________________________________________________________________________________________________________________________________________________How long has this patient attended your office? Years____ Months_________________________ Weeks_____________________PHYSICIAN’S NAME: (print) _____________________________________________________ DATE: _______________________________ADDRESS: ____________________________________________________________________________________________________________CITY, STATE, ZIP: _________________________________________________________ PHONE: ____________________________________

PHYSICIAN’S SIGNATURE: ____________________________________________________________________________________________

Internship Program

CONFIDENTIAL REFERENCE FORM: EMPLOYER / TEACHERTO THE APPLICANT: Please complete the information below and provide a stamped envelope addressed to the below address for the person filling out this form. Full Name: (First)_________________________(Middle)____________________(Last/Family)___________________________________Current Address: _____________________________________________________________________________________________________City: _____________________________________________________ State/Province: ____________________________________________Postal/Zip Code: __________________________________________ Country: ___________________________________________________Phone Number: __________________________________________ Email: ____________________________________________________I, the above named applicant, WAIVE any right to have or obtain copies of this recommendation. Applicant’s Signature: ____________________________________ Date: ____________________________________________________The above applicant has applied for admission to the Faith Family Church Internship Program.Serious consideration will be given to your comments; therefore, we ask that you complete this form carefully. Your prompt attention in completing this form (within 7 days) is important. Thank you for your assistance.Please check the following and comment where necessary:How long have you known the applicant? _________________ How well do you know the applicant? ☐ Very Well ☐ Well ☐ CasuallyPlease rate, according to what you have observed, the applicant’s effectiveness in the following areas:

Superior Above Average Below Inferior Initiative ☐ ☐ ☐ ☐ ☐Social Adaptability ☐ ☐ ☐ ☐ ☐Concern for Others ☐ ☐ ☐ ☐ ☐Ability to Follow ☐ ☐ ☐ ☐ ☐Leadership ☐ ☐ ☐ ☐ ☐Judgment/Decision-making ☐ ☐ ☐ ☐ ☐Emotional Stability ☐ ☐ ☐ ☐ ☐Health ☐ ☐ ☐ ☐ ☐Personal Appearance ☐ ☐ ☐ ☐ ☐COMMENTS ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Mental Ability ☐ Quick to comprehend ☐ Average ☐ SlowIndustry ☐ Hard worker ☐ Average ☐ Lacks persistenceReliability ☐ Meets obligations ☐ Average ☐ Neglects obligationsCooperativeness ☐ Works well with others ☐ Average ☐ Avoids group activityFlexibility ☐ Open to change ☐ Average ☐ UnyieldingChristian Character ☐ Well balanced ☐ Average ☐ UnstableDisposition ☐ Cheerful ☐ Average ☐ Passive

Internship Program

Punctuality ☐ Punctual ☐ Average ☐ Often late Financial Responsibility ☐ Honors obligations ☐ Average ☐ Neglectful COMMENTS ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Internship Program

To what extent is the applicant active in church work? ________________________________________________________________Does he/she display high moral standards? ☐ Yes ☐ No Comment: _____________________________________________Is he/she prejudiced against groups, races, or nationalities? ☐ Yes ☐ No Please explain: _______________________________________________________________________________________________________________________________________________With reference to his/her Christian service, do you consider the applicant to be: ☐ Dedicated ☐ Average ☐ CasualPlease explain: _______________________________________________________________________________________________________In your consideration, which of the following best describes the applicant’s Christian experience?☐ Mature ☐ Contagious ☐ Genuine and Growing ☐ Over-emotional ☐ SuperficialComments: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________Overall, what do you consider to be the applicant’s strong points, including special abilities: _________________________________________________________________________________________________________________________________________________Please comment on the applicant’s family background (if known): ___________________________________________________________________________________________________________________________________________________________________________In your opinion, what are the applicant’s reasons for applying to the program? ______________________________________________________________________________________________________________________________________________________________What could the Internship Program do to aid in the applicant’s personal development? ______________________________________________________________________________________________________________________________________________________Please add any other relevant remarks (i.e., medical, psychological, drugs, alcohol, sexual issues, or other areas of their life we should know more about, to be of service to them): _____________________________________________________________________________________________________________________________________________________________________________Would you recommend the applicant for acceptance into the FFC Internship Program?☐ Yes ☐ With Some Reservation (please explain) ☐ No (please explain)_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

I have known _________________________________________________________________________ for ____________________________________years and believe that he/she possesses the qualities indicated above. Signature: ________________________________________________ Date: ____________________________________________________Name (please print): _____________________________________ Position: _________________________________________________Address: _____________________________________________________________________________________________________________City: _____________________________________________________ State/Province: __________ Postal/Zip Code: ________________Country:________________________________________ Phone:________________________________ Email: ______________________

☐ Please send me more information about the FFC Internship program.Faith Family Church Internship program admits interns of any race, color, national, and ethnic origin to all rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not

Internship Program

discriminate on the basis of race, color, national, and ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs.

Internship Program

CONFIDENTIAL REFERENCE FORM: FRIENDTO THE APPLICANT: Please complete the information below and provide a stamped envelope addressed to the below address for the person filling out this form. Full Name: (First)_________________________(Middle)____________________(Last/Family)___________________________________Current Address: _____________________________________________________________________________________________________City: _____________________________________________________ State/Province: ____________________________________________Postal/Zip Code: __________________________________________ Country: ___________________________________________________Course: __________________________________________________ Date Applying For: _______________________________________Phone Number: __________________________________________ Email: ____________________________________________________I, the above named applicant, WAIVE any right to have or obtain copies of this recommendation. Applicant’s Signature: ____________________________________ Date: ____________________________________________________The above applicant has applied for admission to the Faith Family Church Internship Program. Serious consideration will be given to your comments; therefore, we ask that you complete this form carefully. Your prompt attention in completing this form (within 7 days) is important. Thank you for your assistance.Please check the following and comment where necessary:How long have you known the applicant? _________________ How well do you know the applicant? ☐ Very Well ☐ Well ☐ CasuallyPlease rate, according to what you have observed, the applicant’s effectiveness in the following areas:

Superior Above Average Below Inferior Initiative ☐ ☐ ☐ ☐ ☐Social Adaptability ☐ ☐ ☐ ☐ ☐Concern for Others ☐ ☐ ☐ ☐ ☐Ability to Follow ☐ ☐ ☐ ☐ ☐Leadership ☐ ☐ ☐ ☐ ☐Judgment/Decision-making ☐ ☐ ☐ ☐ ☐Emotional Stability ☐ ☐ ☐ ☐ ☐Health ☐ ☐ ☐ ☐ ☐Personal Appearance ☐ ☐ ☐ ☐ ☐COMMENTS ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Mental Ability ☐ Quick to comprehend ☐ Average ☐ SlowIndustry ☐ Hard worker ☐ Average ☐ Lacks persistenceReliability ☐ Meets obligations ☐ Average ☐ Neglects obligationsCooperativeness ☐ Works well with others ☐ Average ☐ Avoids group activityFlexibility ☐ Open to change ☐ Average ☐ UnyieldingChristian Character ☐ Well balanced ☐ Average ☐ UnstableDisposition ☐ Cheerful ☐ Average ☐ PassivePunctuality ☐ Punctual ☐ Average ☐ Often late Financial Responsibility ☐ Honors obligations ☐ Average ☐ Neglectful COMMENTS ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Internship Program

To what extent is the applicant active in church work? ________________________________________________________________Does he/she display high moral standards? ☐ Yes ☐ No Comment: _____________________________________________Is he/she prejudiced against groups, races, or nationalities? ☐ Yes ☐ No Please explain: _______________________________________________________________________________________________________________________________________________With reference to his/her Christian service, do you consider the applicant to be: ☐ Dedicated ☐ Average ☐ CasualPlease explain: _______________________________________________________________________________________________________In your consideration, which of the following best describes the applicant’s Christian experience?☐ Mature ☐ Contagious ☐ Genuine and Growing ☐ Over-emotional ☐ SuperficialComments: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________Overall, what do you consider to be the applicant’s strong points, including special abilities: _________________________________________________________________________________________________________________________________________________Please comment on the applicant’s family background (if known): ___________________________________________________________________________________________________________________________________________________________________________In your opinion, what are the applicant’s reasons for applying to the program? ______________________________________________________________________________________________________________________________________________________________What could the Internship Program do to aid in the applicant’s personal development? ______________________________________________________________________________________________________________________________________________________Please add any other relevant remarks (i.e., medical, psychological, drugs, alcohol, sexual issues, or other areas of their life we should know more about, to be of service to them): _____________________________________________________________________________________________________________________________________________________________________________Would you recommend the applicant for acceptance into the FFC Internship Program?☐ Yes ☐ With Some Reservation (please explain) ☐ No (please explain)_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________I have known ___________________________________________________________ for____________________________________ years and believe that he/she possesses the qualities indicated above. Signature: ________________________________________________ Date: ____________________________________________________Name (please print): _____________________________________ Position: _________________________________________________Address: _____________________________________________________________________________________________________________City: _____________________________________________________ State/Province: __________ Postal/Zip Code: ________________Country:________________________________________ Phone:________________________________ Email: ______________________

Internship Program☐ Please send me more information about the FFC Internship program.

Faith Family Church Internship program admits interns of any race, color, national, and ethnic origin to all rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national, and ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs.

Internship Program

CONFIDENTIAL REFERENCE FORM: PASTOR / MINISTRY LEADER

TO THE APPLICANT: Please complete the information below and provide a stamped envelope addressed to the below address for the person filling out this form. Full Name: (First)_________________________(Middle)____________________(Last/Family)___________________________________Current Address: _____________________________________________________________________________________________________City: _____________________________________________________ State/Province: ____________________________________________Postal/Zip Code: __________________________________________ Country: ___________________________________________________Course: __________________________________________________ Date Applying For: _______________________________________Phone Number: __________________________________________ Email: ____________________________________________________I, the above named applicant, WAIVE any right to have or obtain copies of this recommendation. Applicant’s Signature: ____________________________________ Date: ____________________________________________________The above applicant has applied for admission to Faith Family Church Internship Program Serious consideration will be given to your comments; therefore, we ask that you complete this form carefully. Your prompt attention in completing this form (within 7 days) is important. Thank you for your assistance.Please check the following and comment where necessary:How long have you known the applicant? _________________ How well do you know the applicant? ☐ Very Well ☐ Well ☐ CasuallyPlease rate, according to what you have observed, the applicant’s effectiveness in the following areas:

Superior Above Average Average BelowAverage Inferior Initiative ☐ ☐ ☐ ☐ ☐Social Adaptability ☐ ☐ ☐ ☐ ☐Concern for Others ☐ ☐ ☐ ☐ ☐Ability to Follow ☐ ☐ ☐ ☐ ☐Leadership ☐ ☐ ☐ ☐ ☐Judgment/Decision-making ☐ ☐ ☐ ☐ ☐Emotional Stability ☐ ☐ ☐ ☐ ☐Health ☐ ☐ ☐ ☐ ☐Personal Appearance ☐ ☐ ☐ ☐ ☐COMMENTS ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Mental Ability ☐ Quick to comprehend ☐ Average ☐ SlowIndustry ☐ Hard worker ☐ Average ☐ Lacks persistenceReliability ☐ Meets obligations ☐ Average ☐ Neglects obligationsCooperativeness ☐ Works well with others ☐ Average ☐ Avoids group activityFlexibility ☐ Open to change ☐ Average ☐ UnyieldingChristian Character ☐ Well balanced ☐ Average ☐ UnstableDisposition ☐ Cheerful ☐ Average ☐ PassivePunctuality ☐ Punctual ☐ Average ☐ Often late Financial Responsibility ☐ Honors obligations ☐ Average ☐ Neglectful COMMENTS _________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Internship Program

To what extent is the applicant active in church work? ________________________________________________________________Does he/she display high moral standards? ☐ Yes ☐ No Comment: _____________________________________________Is he/she prejudiced against groups, races, or nationalities? ☐ Yes ☐ No Please explain: _______________________________________________________________________________________________________________________________________________With reference to his/her Christian service, do you consider the applicant to be: ☐ Dedicated ☐ Average ☐ CasualPlease explain: _______________________________________________________________________________________________________In your consideration, which of the following best describes the applicant’s Christian experience?☐ Mature ☐ Contagious ☐ Genuine and Growing ☐ Over-emotional ☐ SuperficialComments: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________Overall, what do you consider to be the applicant’s strong points, including special abilities: _________________________________________________________________________________________________________________________________________________Please comment on the applicant’s family background (if known): ___________________________________________________________________________________________________________________________________________________________________________In your opinion, what are the applicant’s reasons for applying to the program? ______________________________________________________________________________________________________________________________________________________________What could the Internship Program do to aid in the applicant’s personal development? ______________________________________________________________________________________________________________________________________________________Please add any other relevant remarks (i.e., medical, psychological, drugs, alcohol, sexual issues, or other areas of their life we should know more about, to be of service to them): _____________________________________________________________________________________________________________________________________________________________________________Would you recommend the applicant for acceptance into the FFC Internship Program?☐ Yes ☐ With Some Reservation (please explain) ☐ No (please explain)_______________________________________________________________________________________________________________________

I have known _________________________________________________________________________ for ____________________________________years and believe that he/she possesses the qualities indicated above. Signature: ________________________________________________ Date: ____________________________________________________Name (please print): _____________________________________ Position: _________________________________________________Address: _____________________________________________________________________________________________________________City: _____________________________________________________ State/Province: __________ Postal/Zip Code: ________________Country:________________________________________ Phone:________________________________ Email: ______________________

Internship ProgramFaith Family Church Internship program admits interns of any race, color, national, and ethnic origin to all rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national, and ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs.