PLTS Internship Student Application & Placement

Part I: Personal Information

First Name

Last Name

Email

Phone

Pronouns

Advisor

Academic Year of Intended Internship

Synod of Candidacy

Date of Endorsement

Have you submitted a Petition for Geographic Restriction?

Yes

No

Are you applying for an ELCA Horizon International Internship?

Yes

No

Second (or more) Career?

Yes

No

First Career

Emergency Contact

Name

Relationship

Primary Phone

Mobile Phone

Country

Street

City

Region

Postal Code

Email Address

Part II: Household

Will others be living with you on internship?

Yes

No

DeleteHousehold Member _ID_
Name Relationship Age

Add Household Member

Minimum number of bedrooms needed for housing

Other needs to be considered for housing

Do you have a pet or intend to have a pet on Internship?

Yes

No

DeletePet _ID_
Pets
Pet Name Type of pet

Add pet

Part III: Previous Work Experience

DeleteJob _ID_
Work Experience: Please list your 3 most recent jobs
Employer/Location Job Title Dates

Add Job

DeleteExperience _ID_
Congregational Experience: Please list your 3 most recent experiences
Congregation/Location Leadership Role(s) Dates

Add experience

DeleteSite _ID_
Ministry in Context Sites
Ministry/Location Supervisor Dates

Add Site

Part IV: Placement Factors: Geographical and Contextual Preferences

Rank your placement priorities in order of importance, with 1 as the highest priority and 4 as the lowest priority.

Geographical Area

Housing

Type of Congregation

Type of Supervisor

Comments

Rank your community context preferences with 1 as the highest and 6 as the lowest.

Rural

Town/Country (pop. 5,000 - 10,000)

Small City (pop. 10,000 - 100,000)

Suburban

Urban

Inner City

Comments

Part V: Other Placement Factors

Describe your vehicle situation:

Do you have a vehicle to bring with you on internship?

Yes

No

What form(s) of transportation do you have?

Note: Most sites require interns to have a vehicle. If you do not own a vehicle, please indicate whether you could have access to one for the time while you are on internship:

Yes

No

What type of vehicle?

What is the condition of your vehicle?

Excellent

Good

Fair

Needs some repairs

Is your vehicle safe to drive in snow?

Yes

No

Comments

Are there health factors limiting the place or type of internship? If so, please explain.

What particular areas of ministry you would like to experience, if at all possible, during internship (e.g., campus, multicultural, mission start, ecumenical, interfaith, preschool, etc.?)

Most internships begin in early August or early September. If your starting date is restricted in any way, please explain.

What direction or suggestions has your Candidacy Committee offered about your internship placement?

Part VI: Personal Assessment

Please rate your reading and conversational abilities with any languages you speak.

Household Language

Reading Ability

Conversational Ability:

DeleteLanguage _ID_
Additional Languages
Language Reading Ability Conversational Ability:

Add Language

What type of ministry do you hope to be called to for a first call setting?

Identity three (3) areas of growth you hope to address during internship.

Assess your personal and professional strengths and needs at this time:

Personal

Strengths

Needs

Professional

Strengths

Needs

What excites you as you anticipate internship?

What concerns do you have as you anticipate internship?

What are qualities in a supervisor that would be most helpful to you, and why?

Describe your temperament and work style. What makes it easy and difficult to work with you?

When asked to put together a new project, describe your usual creative process.

What are your hobbies or special interests?

What additional information do you deem important for your placement?

Part VII: Personal Autobiography

Please attach an autobiography of 1-2 pages, single-spaced, to this document. This will be shared with supervisors during the discernment process.

Part VIII: Review and Signature

Please carefully review your application. After you have done so, please sign below to verify that this information is true and complete, to the best of your knowledge:

Student Signature