Evaluation for Ministerial Internship MIP - English

Please print clearly (or fill in online) this from as applicable. The data herein contained
is subject to verification. If your information is supportable, you may receive credits
ranging from a minimum of three (3) hours to a maximum of fifteen (15). Those hours
granted will be solely at the schools discretion. In this connection, it is important that
you are careful to submit any and all information necessary to our decision. The charge
for such credits will be assessed at $20.00 per hour. For example, if fifteen (15) hours
are awarded, the fee will be $300.00. Place an “N/A” in those sections that do not
pertain to you.

Personal Information
Name Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Social Security if Available
Phone Phone - ### - ### ####
Email
1. ARE YOU A:
Commissioned Minister Liscensed Minister Ordained Minister
How Long? Please Provide Length of Each Individual Title
2. WHOM DO YOU PRESENTLY SERVE UNDER
Name Name First Last
Title
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Phone Phone - ### - ### ####
3. STARTING WITH THE PRESENT CHURCH, LIST THE LAST THREE YOU ATTENDED
Please provide:
1. Name and Location of the Church
2. Phone Number
3. Senior Pastor at Time of Attending
4. Dates Attended (From: To:)
4. NAME THREE MAJOR COMMITTEES THAT YOU HAVE SERVED ON
Provide the Name of the Committee and the Length of Service
5. LIST THOSE AREAS OF COMMUNITY SERVICE IN WHICH YOU HAVE PARTICIPATED
6. PLEASE LET US KNOW ID YOU HAVE BEEN INVOLVED IN ANY OF THE FOLLOWING
Service

Service 1. Children 2. Preteens 3. Youth 4. Young Adults 5. Senior Adults 6. Prision 7. Pastoral Counseling 8. Evangelism 9. Inner City 10. Inercession 11. Music 12. Other 12. Other
Provide the Term of Service for Each Service Participated in
Formal Program (Check Box if Yes for Corresponding Number to Service)

Formal Program (Check Box if Yes for Corresponding Number to Service) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
A formal program is one that is fully documented and subject to authority-review. If any of these ministries are self-directed, please indicate by answering “No”. It is most important for you to realize that self-directed ministries are often very effective and, in many instances, we have recognized the efforts in these areas for the purpose of extending earned credits.
7. IF YOU HAVE SERVED IN THE MISSION FIELD, PLEASE STATE WHERE AND FOR HOW LONG
8. RESUME OF MINISTERIAL FUNCTIONS
How many sermons have you preached over the past two years?
How many weddings have you conducted?
How many funerals have you presided over?
9. NAME THREE BOOKS (OTHER THAN THE BIBLE) THAT MOST INFLUENSED YOUR WALK
Please Provide the Name of the Book and the Author
10. LIST THOSE MAJOR BOOKS OR ARTICLES THAT YOU HAVE WRITTEN
Please Provide the Name of the Work and the Number of Pages or Number of Words
11. PLEASE LIST THOSE ITEMS IN 10 ABOVE THAT WERE USED FOR PRIOR ACADEMIC CREDIT
12. PLEASE LIST THOSE LANGUAGES THAT YOU SPEAK FLUENTLY
13. PLEASE DETAIL OTHER QUALIFYING INFORMATION THAT IS NOT ADDRESSED IN THE ASSESSMENT
14. WHAT DO YOU CONSIDER TO BE YOUR STRONGEST AREAS OF STUDY?
15. WHAT AREAS OF STUDY WOULD BE MOST APPROPRIATE TO INCLUDE IN YOUR CURRICULUM?
16. Thanks for getting this far. The last task we ask of you is to express in at least 250
words the direction or destiny you believe God is calling you to. It should be no secret that
we are not only using this piece to serve you better but also to see the quality of your writing
skills.
PLEASE SIGN AS INDICATED AND HAVE TWO RESPONSIBLE AUTHORITIES CERTIFY THIS APPLICATION
Applicant

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY
Certified By Certified By First Last
Phone of Certifier Phone of Certifier - ### - ### ####
Certified By Certified By First Last
Phone of Certifier Phone of Certifier - ### - ### ####

Evaluation for Ministerial Internship MIP - English

Evaluation for Ministerial Internship MIP - English

Personal Information

1. ARE YOU A:

2. WHOM DO YOU PRESENTLY SERVE UNDER

3. STARTING WITH THE PRESENT CHURCH, LIST THE LAST THREE YOU ATTENDED

4. NAME THREE MAJOR COMMITTEES THAT YOU HAVE SERVED ON

5. LIST THOSE AREAS OF COMMUNITY SERVICE IN WHICH YOU HAVE PARTICIPATED

6. PLEASE LET US KNOW ID YOU HAVE BEEN INVOLVED IN ANY OF THE FOLLOWING

7. IF YOU HAVE SERVED IN THE MISSION FIELD, PLEASE STATE WHERE AND FOR HOW LONG

8. RESUME OF MINISTERIAL FUNCTIONS

9. NAME THREE BOOKS (OTHER THAN THE BIBLE) THAT MOST INFLUENSED YOUR WALK

10. LIST THOSE MAJOR BOOKS OR ARTICLES THAT YOU HAVE WRITTEN

11. PLEASE LIST THOSE ITEMS IN 10 ABOVE THAT WERE USED FOR PRIOR ACADEMIC CREDIT

12. PLEASE LIST THOSE LANGUAGES THAT YOU SPEAK FLUENTLY

13. PLEASE DETAIL OTHER QUALIFYING INFORMATION THAT IS NOT ADDRESSED IN THE ASSESSMENT

14. WHAT DO YOU CONSIDER TO BE YOUR STRONGEST AREAS OF STUDY?

15. WHAT AREAS OF STUDY WOULD BE MOST APPROPRIATE TO INCLUDE IN YOUR CURRICULUM?

16. Thanks for getting this far. The last task we ask of you is to express in at least 250 words the direction or destiny you believe God is calling you to. It should be no secret that we are not only using this piece to serve you better but also to see the quality of your writing skills.

PLEASE SIGN AS INDICATED AND HAVE TWO RESPONSIBLE AUTHORITIES CERTIFY THIS APPLICATION

16. Thanks for getting this far. The last task we ask of you is to express in at least 250
words the direction or destiny you believe God is calling you to. It should be no secret that
we are not only using this piece to serve you better but also to see the quality of your writing
skills.