2024 Impact Summerfest Internship Application

Applications are received and Interns are accepted without regard to race, creed, color, sex, national origin, physical or mental handicap, veteran's status and citizenship status.

Please submit this completed application with a cover letter/ short essay explaining why you would like to serve as an intern to PCG Impact Student Ministries. Please note, anyone over the age of 18 may be subject to a background check
PERSONAL INFORMATION
Name Name First Middle Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Cell Phone Cell Phone - ### - ### ####
Email
Gender

Gender Male Female
Age
Date of Birth Date of Birth / MM / DD YYYY
Birthplace (City/ State)
Are you a citizen of the United States:

Are you a citizen of the United States: Yes No
Have you ever been convicted of any crime other than a minor traffic violation?

Have you ever been convicted of any crime other than a minor traffic violation? Yes No
If yes, please explain
Emergency Contact Name Emergency Contact Name First Last
Relationship
Phone Phone - ### - ### ####
What do you like to do for fun?
Do you have any allergies?

Do you have any allergies? Yes No
If yes, please list:
Do you take any prescription medication?

Do you take any prescription medication? Yes No
If yes, please list medication:
CHURCH INFORMATION
Name of home Church
Pastor's Name
Location (City, State)
Phone Phone - ### - ### ####
How long have you been a member of this church?
Have you volunteered in any capacity?

Have you volunteered in any capacity? Yes No
If yes, please list areas and length of time for each
Name of person you currently serve under
INTERNSHIP INFORMATION
Please tell us briefly about your background and how you became a Christ Follower
What area of ministry are you passionate about/ called to?
EDUCATION
Name of High School
Graduation Date/ Year
Location (City, State)
Please list colleges, universities, or other schools you have attended, as well as the dates attended and the Degrees's received
PERSONAL REFERENCES
REFERENCE #1
Name Name First Last
Phone Phone - ### - ### ####
Years known
Relationship
REFERENCE #2
Name Name First Last
Phone Phone - ### - ### ####
Years known
Relationship
APPLICANT'S SIGNATURE

The information I have given is correct and may be verified by Impact Student Ministries if necessary. I understand that if I am admitted to the Internship Program, Impact Student Ministries reserves the right to disqualify me from the Internship Program for any reason it deems appropriate. I hereby release PCG Impact Student Ministries harmless from all claims arising under this application. I further understand that a criminal record check may be conducted on me and I consent to any such check.
Signature

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
COST

$150 per person
A non-refundable deposit of $50 is due by May 15th. Full payment is due June 15th.
Payments are tax-deductible and can be made online at www.impactym.com or by mailing a
check made out to PCG Impact Student Ministries P O Box 211866 Bedford, TX 76095. Please
place in the memo “Summer Camp Team.”

Cost Includes: Lodging, 1 meal per day, transportation during the internship, Summerfest event pass ($55 value), Six-flag ticket ($44 value), team apparel.

Costs Does Not Include: Travel to and from Dallas/Fort Worth, Souvenirs, personal items, medications, additional meals (1 meal a day will be provided)

Before arranging flights, please check with Impact Office to verify times and airports are
convenient and work within our schedule.

2024 Impact Summerfest Internship Application

2024 Impact Summerfest Internship Application

PERSONAL INFORMATION

CHURCH INFORMATION

INTERNSHIP INFORMATION

EDUCATION

PERSONAL REFERENCES

REFERENCE #1

REFERENCE #2

APPLICANT'S SIGNATURE

COST