APPLICATION FOR HOST SITE

The Ministry Internship Project | Young Clergy Initiative

Greater Northwest Episcopal Area of The United Methodist Church

Date Application to Host Intern:

 Full-time 10-week summer term (’15)

A. NAME OF MINISTRY SETTING:

ADDRESS:

PHONE: FAX:

LOCAL CHURCH/AGENCY E-MAIL:

NAME OF SUPERVISOR:

•Do you expect a change in supervision during the term of the placement? YesNo

•Is the supervisor ordained? Yes No

•Does the supervisor have a Master of Divinity or equivalent degree? Yes No

ADDRESS:

HOME PHONE: CELL:

SUPERVISOR’S E-MAIL:

We will be corresponding by email. Please CIRCLE the email address you check regularly. If email access is not available, we will correspond through the U.S. Postal Service.

B. LOCAL CHURCH/AGENCY DESCRIPTION (if applicable):

Conference District

Number of Members/Constituents

Number of Professional Staff

C. LEARNING PLAN:

The YCI Internship Project seeks to maximize the learning potential of the intern by establishing appropriate educational expectations.

Will you and your local church/agency (check box to affirm):

 Participate in supervisor/intern orientation?

 Grant the intern identity as a ministering person and allow him/her to exercise an appropriate range of ministerial responsibilities under your careful supervision?

 Use the Learning/Serving Covenant to establish clear goals for the intern and
expectations of the ministry?

 Provide for the intern regular supervisory conferences with theological reflection and a final joint review of learning attained and to be attained?

 Offer intentional support from other members/constituents for the intern to
encounter the perspective and support of laity?

D. SERVICE PLAN:

1. Please indicate how you will identify the intern in your ministry, (student associate minister, ministerial intern, etc.)

2. What role(s) will the intern hold in your ministry setting? Interns should expect structure and support in their involvement. It is understood this is a tentative profile of an intern’s role in your ministry. Except in limited instances, theintern is not expected to carry the full responsibility for programs or ministries of the placement.

3. Are there specialized skills or experiences required for the expectations noted under #2?

4. Do you have need for the intern to begin the internship on a date other than the official date

established by the grant administrator? Yes No

If yes, what date are you requesting the placement to begin

E. FINANCIAL PLAN. The ministry setting is required to provide housing and health benefits for the intern. An additional cost of living stipend, or professional expenses allotment, provided by the ministry setting is optional but may be appreciated.

$ YCI Grant Support (Maximum of $5,000)

$ Health Benefit Cost (ACA)

$ Housing Arrangement and Support Costs

$ Cost of Living Stipend or Professional Expenses Allotment

F. OTHER FINANCIAL SUPPORT:

Transportation Expenses for Summer Placements:.All internsare reimbursed by the conference for travel costs incurred to attend YCI project meetings and retreats.

Housing:Housing is provided by the ministry setting either through the use of a parsonage or housing allowance. Meals and transportation are the responsibility of the intern except as noted above.

COVENANT: We, the undersigned, covenant with The Greater Northwest Episcopal Area to provide the support, service and learning opportunities, as outlined in this application, to the best of our abilities.

SIGNED

Pastor/SupervisorLaity Representative

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