Immersion Experience Application
Please submit your application with the following application materials:
Personal Testimony (250 – 1000 words) (250 – 1000 words)Please include this typed as a separate document
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Date Completing Application
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Date of Birth
*
-
Month
-
Day
Year
Date
Age:
Current Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Is this your permanent address?
*
Yes
No
Permanent Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Marital Status
Single
Married
Divorced
Widowed
Separated
Gender
*
Male
Female
Have you previously applied for any of the following Dream Center programs?
Philly Dream Center Internship
Valley Forge University Advanced Site
Other
If yes, when?
-
Month
-
Day
Year
Date
Which start month are you applying for?
January
March
May
June-July
September
November
How long would you like to stay?
Summer
6 Months
12 Months
How did you hear about The Dream Center?
Philly Dream Center Website
Friend or family member
SALT Conference
General Council
Philly Dream Center staff/ resident:
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Education
High School
*
Dates Attended:
Did you graduate?
*
Yes
No
Did you attend Postsecondary school?
*
Yes
No
College/University (Undergraduate):
Dates Attended:
Major/ Degree
Did you graduate?
Yes
No
College/University (Graduate):
Dates Attended:
Did you graduate?
Yes
No
Major/ Degree
Please list any additional information that you believe may be useful in our evaluation of your application (example: computer literacy, software/hardware experience, special training programs, certificates, or courses you have participated in or are experienced in which are not reflected above):
Please sign below agreeing that you are willing and physically able to serve 35-40 hours a week in the ministry you are assigned to.
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Ministry Experience
Have you participated in any other ministry training programs, Bible schools, Masters Commission, leadership schools, etc.? If so, please list, including approximate dates:
*
Have you ever participated in any mission trips or local outreaches? If so, please list, including approximate dates:
*
Have you ever been dismissed from any ministry or volunteer work? If so, please explain:
*
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EMPLOYMENT EXPERIENCE
Upload your resume
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Company 1
Company Name:
Position/ Title
Phone Number
Please enter a valid phone number.
Supervisor:
Company Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Description of Duties:
Start Date
-
Month
-
Day
Year
Date
Are you still working here?
Yes
No
End Date
/
Month
/
Day
Year
Date
Reason for leaving:
Company 2
Company Name:
Position/ Title
Phone Number
Please enter a valid phone number.
Supervisor:
Company Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Description of Duties:
Start Date
-
Month
-
Day
Year
Date
End Date
/
Month
/
Day
Year
Date
Reason for leaving:
Company 3
Company Name:
Position/ Title
Phone Number
Please enter a valid phone number.
Supervisor:
Company Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Description of Duties:
Start Date
-
Month
-
Day
Year
Date
End Date
/
Month
/
Day
Year
Date
Reason for leaving:
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References
Please list THREE references below.
Professional Reference
Name:
*
Relationship
*
Phone Number
Please enter a valid phone number.
Email Address:
example@example.com
Number of years known
Address:
PASTORAL REFERENCE
Name:
*
Relationship
*
Phone Number
Please enter a valid phone number.
Email Address:
example@example.com
Number of years known
Address:
PERSONAL REFERENCE
Name:
*
Relationship
*
Phone Number
Please enter a valid phone number.
Email Address:
example@example.com
Number of years known
Address:
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SUBMIT
SUBMIT
Should be Empty: