PLTS Internship Arrival Form (Word and Sacrament)

First Name

Last Name

Pronouns

Home Address (while on internship)

Country

Street

City

Region

Postal Code

Cell Phone Number

Period of Internship

Start Date

End Date

Ministry Site Information

Ministry Site Name

Country

Street

City

Region

Postal Code

Phone Number

Website Address

Supervisor Contact Information

Name

Pronouns

Phone

cell

office

Weekly Supervisor Meetings

Day

Time

Lay Committee Chair

Name

Pronouns

Phone

cell

office

home

Lay Committee Meeting Schedule

Congregational Financial Commitment

Stipend (minimum $2,000 per month)

Business Mileage Reimbursement/mile

If congregation assists with FICA payments, to what degree? (dollar amount):

Other Financials
select all that apply

Housing and utilities reimbursed

Housing and utilities paid directly to landlord

Housing owned and utilities paid by ministry

Housing not provided (must be previously agreed upon with approval by the Director of Contextual Education)

Internship Administrative Fee ($1,500.00)

Comments on above as needed