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Missions Internship Application

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Missions Internship Application

Missions Internship ApplicationDOVE USA2024-08-28T12:51:54-04:00

"*" indicates required fields

Personal Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Phone*

Birthday*

Month

Day

Year

Gender*

Female

Male

Current career*

Home church*

Pastor name*

How are you serving or have served in your church?*

Agreements

Please select to agree.*

I will obtain a child abuse clearance from my state and forward to the DMI office.

Please select to agree.*

If approved, I will submit $1,000 for booking a flight three months prior to the start date of the internship.

Please select to agree.*

I understand that it is my responsibility to raise the monthly living costs set by DMI.

Passport Information

Note: This information must be accurate. Type your name exactly as it is written in your passport. If you do not have a passport (or your current passport expires six months after your internship, please apply for a new one.

Do you have a valid US passport?*

Yes

No

Please select to agree.*

I understand that it is my responsibility to apply and pay for a US passport.

Name exactly as printed on passport*

Passport number*

Date of issue*

Month

Day

Year

Date of expiration*

Month

Day

Year

Medical Information

Do you have health insurance?*

Yes

No

Name of health insurance carrier*

Phone*

Policy number*

Member's name*

Do you have any physical limitation that may affect your participating in any activity?*

Please check all boxes that apply to you.

Allergies

Asthma

Diabetes

Operation within the last year

Bee/Wasp allergy

Hay fever

Heart trouble

Pregnant

High blood pressure

Physical disability

Dizziness or fainting

Epilepsy

Penicillin allergy

Respiratory problems

Dietary restrictions

Please explain any of the above conditions if needed.

Medications

Please list any medications you take and the condition being treated. Use the + symbol to the right to add multiple lines.

Medication

Condition

Please select to agree.*

I consent to emergency medical treatment deemed necessary in the unlikely event of an accident. I will pay for any and all expenses incurred should insurance not cover them. I also release DOVE Mission International, the host ministry and staff from any liability resulting from any accident or illness.

Emergency contacts*

Please list two emergency contacts and their contact information. Use the + button on the right to add a row.

Name

Relationship to you

Primary phone number

Email

Outreach Information and Personal Testimony

Which internship are you applying for?*

Please explain your reasons for choosing this particular assignment.*

What prior missions experience do you have?*

What is your plan to cover finances for this internship?*

How did you hear about this internship?*

How long have you been a Christian? How is God working in your life now?*

Please select to agree.*

By signing below, I agree that the above information is correct to the best of my knowledge. I also understand that the due date for my application is four months prior to the starting month of the internship. (For example, if you are applying for an internship starting in June, the application is due at the beginning of February.)

Signature*

Internship Application Fee*

Price:

Total

Δ

DOVE USA

Address
11 Toll Gate Road
Lititz, PA 17543

Phone
(717) 627-1996

Email
info@doveusa.org

Office Hours
Monday – Friday 8:00 AM – 4:30 PM EST