Complete and submit this form to be considered for a Lifechangers internship.

    First Name Last Name

    Email Address

    Best phone number to reach you

    Extension

    Address Line 1

    Address Line 2

    City

    State

    ZIP Code

    Church where you are a member:

    Do you have health insurance?

    YesNo

    Have you ever been convicted of a felony?

    YesNo

    Have you ever been convicted of sexual harassment or abuse?

    YesNo

    Have you ever been convicted of child endangerment, abuse, or neglect?

    YesNo

    Name of your pastor

    What ministries have you been involved in through your church or other Christian organizations?

    What language do you speak, other than English?

    NoneSpanishPortugueseChineseKoreanOther

    Reference #1: Give name, your relationship to this person, email address, and best phone number:

    Reference #2: Give name, your relationship to this person, email address, and best phone number:

    Tell us about your walk with Jesus:

    Why do you want to serve as a Lifechangers intern?

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