Seventh Day Baptist Summer Christian Service Corps

Seventh Day Baptist Summer Christian Service Corps

A Summer of Service, a Lifetime of Leadership

Rookie/VetApplication

“Not to be served, but to serve” Matthew 20:20-28

Return to: SCSC CommitteeCell Phone:Helen Goodrich, 308-219-0053

P.O. Box 164E-mail:

North Loup, NE 68859Website:

Onsite Training Arrival Date:June 15, 2016

IF YOU THINK YOU MIGHT HAVE A CONFLICT WITH THE SCSC JUNE 15TH TRAINING ARRIVAL DATE, DO NOT SUBMIT THIS APPLICATION. PLEASE CALL THE SCSC COMMITTEE CHAIR,

HELEN GOODRICH, 308-219-0053.(for more specific information, see the Timeline or website)

You are responsible the cost of Conferenceand for arranging your own transportation home from Conference.

The deadline for this application and accompanying REQUIRED items isJanuary 8, 2016.

Please type or print clearly.

I. Personal InformationToday’s Date: ____/____/_____

1. Name in full ______Male ______Female ______

2. Name you prefer to be called, if different ______

3. D.O.B. _____/_____/_____ How old will you be June 15th? ______

4. Permanent Home Address ______

City ______State ______Zip ______

5. School Address, if applicable ______

City ______State ______Zip ______

6. Which address should we use to send your materials? Home ______School _____

7. YOUR Phone: ( ) ______Email Address* ______(print legibly)

NOTE: An e-mail address and Facebook account is *REQUIRED for communication and posting of assignments. Probationary acceptance will initially be communicated electronically.

8. Parent/Guardian (with whom you live when not away at school): ______

Parent/Guardian Phone: ( ) ______Email Address ______(print legibly)

9. Mark the year of education completed as of June15, 2016.

High School ____ College: 1 2 3 4 Date school term ends _____/_____/____

10. College you plan to attend next year ______

City ______State ______Zip ______

II. Church Participation

1. When did you commit your life to Jesus Christ as Savior? Age: _____and/or Date_____/______/______

(approximate age and date are acceptable)

2. Where is your Seventh Day Baptist Church membership? ______(*REQUIRED)

3. Date of baptism ____ /____ /_____ Date of membership ____ /____ /____(*REQUIRED)

II. Church Participation (continued)

4. Have you ever attended church camp? Yes No

Where? ______Number of years? _____

1. What church(es) did you attend this last year? ______
2. What specific services have you provided to the church(es) or a Christian organization that you attended this last year? (include leadership or servant hood type activities) ______

**NOTE: You are REQUIRED* to turn in a Dedicated Service Pre-Training Assignment, documenting

10 hours (for Rookies) and/or 20 hours (for Vets) of Dedicated Service to a church or Christian organization completed between September to May of this school year. You must give specifics of your service and/or leadership and with a supervisor’s signature. This pre-training assignment is due upon arrival at SCSC onsite TrainingJune 15,2016, should you be accepted into the program.

III. Personal Faith/Relationship with Christ

Write a short paragraph about each of the following subjects. (add paper/use the back if needed)

A. Briefly describe how you gave your life to Jesus Christ.

______

______

______

B. Tell about your personal Sabbath conviction, i.e. What does the Sabbath mean to you?

______

______

______

C. How has your personal relationship with Christ impacted your life in terms of home, school, and work?

______

______

______

D. What led you to consider serving in SCSC? ______

______

______

______

E. List any convictions you have that the SCSC Committee, Host Church and Project Director need to know such as, vegetarian, not eating pork, or not going to a restaurant on the Sabbath, etc.

IV. Skills/Abilities/Talents/Spiritual Gifts (Specifically include any leadership and/or servant hood.)

1. List your extra-curricular activities in High School and College,

A. Music______

* Led Singing______*Instruments played______

* Years of Experience______* Comfort level in group setting______

Other musical expertise ______

B. Drama______

C. Art______

Other ______

D. Computer skills**______Hardware______Software______

Word Processing ______Excel______Programming ______

List other programs______

**Note: Your assignments will be placed on Facebook. It will be REQUIRED* that you have a Facebook account and necessary to have regular access to the internet. If accepted into the program, you will be contacted by e-mail as well as by phone. Some materials will be mailed to you through USPS. Upon acceptance, you will be added to a private Facebook account for communication and completion of most of the pre-training assignments.**

E. Sports/Athletics, both team and individual (include any leadership experiences)______

______

F. Foreign languages, including Sign Language______

______

G. Clubs (include any leadership experiences) ______

______

H. Employment (include any leadership experiences)______

______

I. Previous Summer activities that show leadership and/or servant hood training ______

______

J. Other Leadership/and/or Servant hood experience or training______

1. Spiritual Gifts

Have you ever taken a spiritual gifts inventory? ______If yes, what are your spiritual gifts? ______

If no, what do you think your spiritual gifts might be? ______

V. Please answerYes or No to the following questions

Have you ever….

______been the subject of an investigation regarding child abuse?

______been in any kind of trouble with a law enforcement agency?

______been accused or convicted of a crime?

______used or sold illegal drugs or drug paraphernalia?

If you answered yes to any of the above, please explain: ______

______

Please note that you are to refrain from using alcoholic beverages or tobacco while traveling to and from SCSC, at Training, on Project, at Evaluation, and at Conference.

YOU MUST FILL OUT THE BACKGROUND CHECK PERMISSION LOCATED ON THE WEBSITE. THOSE PAGES MUST ACCOMPANY THIS APPLICATION IF YOU ARE 18 YEARS OLD. IF 17, SUBMIT AS SOON AS YOU TURN 18.

VI. **REQUIRED Health History & Emergency Treatment Permission -CONFIDENTIAL -

Note: Your personal information MUST BE at the beginning of this application, completed and in full.

Emergency Contact/Parent /Guardian: ______

Address: ______City: ______State ____ Zip: ______

Phone: ______E-mail: ______

**Note: A copy of your **REQUIRED Health Insurance Information MUST accompany this application.

HEALTH HISTORY -CONFIDENTIAL -

How is your general health? ______

Limitations, if any: ______

Check if
applicable / Date / Medications/Treatments if applicable
Diabetes
Ear Infections
Asthma/Respiratory
Convulsions
Bleeding/clotting disorder
Hypertension
Mononucleosis
Chicken Pox
Mumps
German Measles
Heart Disease/defect
Glasses/Contact lenses
Hearing aid
Past/Recurring injury
Allergies to:
Bee stings/other insects / animals
Hay fever or plants (poison ivy, etc)
Lactose intolerant / gluten/ nuts or other food substances
Medications (specify)
Other

VI Health History and Treatment Permission (continued) -CONFIDENTIAL -

Please answer each of the questions below completely and honestly:

1. Have you ever required psychiatric care? Yes No

Explain (include dates) ______

2. Have you had any major operations or serious injuries? Yes No

Explain (include dates) ______

3a. Do you have a limiting condition (ADD, LD, Autism, Dyslexia, physical) that the Training Director should be aware of when making assignments of extensive reading and writing? Yes No

3b.What kinds of adaptations would be helpful? ______

4. Do you have a chronic or recurring illness? Yes No

Explain (include dates) ______

5. Are there any activities encouraged or limited by physician? Yes No

Explain (include dates) ______

5. Do you require any dietary modifications? Yes No

Explain (include dates) ______

6. Are you currently taking any medications? Yes No

Explain (include dates) ______

Name of your physician: ______Phone :(_____) ______

Date of last physical: ______/______/______(Should be within two years of the current date.)

Please Note:In order to participate in SCSC, you MUST have VALID Health Insurance(applicable in the U.S. or out of the country as in the case of Missions)and supply the SCSC Committee with a copy of your insurance card or information WITH THIS APPLICATION prior to being accepted into the program. If you do not currently have a Health Insurance plan, it is your responsibility to secure one for the summer. If you have questions or need help with this issue, please contact a committee member at

CANADIAN STUDENTS, YOUR INSURANCE WILL NOT WORK IN THE UNITED STATES.

Name of medical insurance company: ______

Name of policy holder: ______

Medical insurance policy number: ______

Medical insurance customer service or contact phone number ______

A COPY OF YOUR VALID HEALTH INSURANCE CARD MUST ACCOMPANY THIS APPLICATION!

The following MUST be completed in order for you to attend and participate in SCSC this summer.

To the best of my knowledge, the information given in this health history is correct. The person herein described has permission to engage in all prescribed SCSC activities unless otherwise noted.

Authorization for Treatment: I hereby give permission for the medical personnel selected by SCSC to order x-rays, routine tests, treatment and necessary transportation for the person herein described. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by SCSC to secure and administer treatment, including hospitalization for the SCSC member named above.

Signature of parent/guardian is *REQUIRED if applicant is less than 21 years of age.

Parent or Guardian Signature______Phone (_____) ______

Date: ______/______/______

VI Health History and Treatment Permission (continued) Physician’s Statement -CONFIDENTIAL-

IT IS REQUIRED* THAT ROOKIES HAVE A MEDICAL DOCTOR FILL OUT THIS PORTION OF THE HEALTH HISTORY.It must be completed and turned into the SCSC Committee prior to having transportation arranged, due to travel safety issues and liabilities. Therefore, we ask that your physical (below) either accompany your completed application, meeting the deadline of Jan. 8, 2016or that you send it by February 28, 2016. *STOP now and get an appointment set up for your physical if you have not had one recently. ***Canadian applicants please check the website for health release to give to your physician.***

*Fill in the following blank with the date of your upcoming medical physical appointment if you are not able to complete this part of the application at this time. Date ___/___/_____

TO BE COMPLETED BY PHYSICIAN:

Name of patient: ______DOB______/______/______

Height______Weight: ______Blood Pressure: ______

Required Immunizations are up to date Yes No

Date of last tetanus booster______/______/______

Limitations: ______

______

I have examined this person and found him/her to be in satisfactory condition, free from heart, lung and throat

disorders; contagious disease, and capable of active participation in such programs as camping and youth work with any exceptions noted above. I also find the health history information found within this completed form to be accurate to the best of my knowledge.

*Physician’s Signature: ______Date:______/______/______

Printed name and address: ______

Phone (_____) ______Name of Clinic or Office ______

*Required!

VII. Project Focus Preferences

(New in 2016) This is your chance to help choose your focus for your on-site leadership development training. Please prayerfully consider the type of service you might prefer. See separate letter outlining the Women’s Board vision for giving students experience in specific ministries of interest. The following focus areas will be offered only if churches apply for a type of project. Below are the focus choices. The focus area will NOT necessarily be the ONLY thing you do while on project, but churches will have applied and asked for this type of project.

LIST YOUR PREFERENCE IN 1-2-3 order, with 1 being your first choice. (If your first focus area is not available we assume that you are willing to work in another area of focus unless you notify us otherwise.)

_____MISSIONS FOCUS _____WORSHIP LEADING FOCUS _____CHRISTIAN EDUCATION FOCUS

VIII. Service Preferences:

If given a choice, in which location would you prefer to serve? (Check all that apply.)

_____ Rural _____ Small town _____ Suburban _____ Urban-metropolitan _____ No preference

With which age groups are you most comfortable? (number: 1 = comfortable, 3 = okay, 5= not comfortable)

_____ Pre-primary _____ Primary _____ Junior _____ Jr. High _____ Sr. High _____ Adult

IX. TRAVEL INFORMATION and T-SHIRT SIZE

1. **REQUIRED You must send in a photocopy of your photo ID (i.e. Driver’s License or College ID). You will use this ID for airport security. We will use it to obtain your ticket in the name that appears on it.

1. The SCSC committee will arrange for your travel to training, to project, and to evaluation. What is the preferred airport for you to fly out of to attend training? (If you do not answer this question, an airport will be chosen for you.) ______

1. The SCSC committee is funded by the Women's Board and SCSC contributions. You will be provided with funds or reimbursed for one piece of checked luggage if required during air travel.

1. Sheets, towels, blankets, and pillows are provided at training by the SCSC Committee and during all weeks on project either through your Project Director or the SCSC Committee.

1. What size t-shirt do you wear? ______

X. Personal References

Please fill in all requested information for the following required references. These should be people who have known you well within the last two years in servant/leadership training capacities. Do not use close relatives, if at all possible.

Rookies are REQUIRED* to have 3 people listed below as potential references. Vets are REQUIRED to have 2 people listed below as potential references, plus the previous year's Project Director.

** The SCSC Committee will be communicating with the references listed to obtain referrals for each student.

YOU, THE STUDENT ARE RESPONSIBLE TO ASK YOUR REFERENCES IF THEY ARE WILLING TO PROVIDE A REFERRAL FOR YOU. LET THEM KNOW THEY WILL BE CONTACTED BY A MEMBER OF THE SCSC COMMITTEE VIA E-MAIL, OR IN THE FORM OF A SURVEY. If we cannot reach your reference by e-mail, we will call them.

Print legibly - ALL INFORMATION MUST BE ACCURATE AND COMPLETE.

Pastor ______

Phone ______Email______

Church Member______

Phone ______Email______

Personal reference (Teacher, College Professor, or Employer)

Name ______

Position______

Phone ______Email______

Personal reference (non-relative) ______

Position or relationship to applicant ______

Phone ______Email______

Past Project Director (if applicable)

Name: ______Church: ______Phone: ______

XI. Your Pre-Planned Fundraising Pre-Training Assignment (2 pages) is to accompany this application to meet the deadline of January 8, 2016. *REQUIRED.

Your assignment is to:

1. Read the following information on Fundraising AND READ the Fundraisingdetails in your

packet or on the website:

1. Pray for the Holy Spirit to guide you clearly in fulfilling this objective. Think about the various ways

you could raise a minimum of $500 for SCSC.

3. Print out and complete the 2 pages of Pre-Fundraising Plans following this page.

4. **After filling out this 2 page form, make a copy to send with this application. Keep a copy for yourself.**

5. Print out a copy of the Post Fundraising Plan page following this application.

6. Contact donors initially and keep an ongoing record of the dates that you send letters, hold fundraisers, etc.

7. Bring your completed Post Fundraising Plan document with you to training to hand in to a staff or committee member. This is a REQUIRED* Pre-training assignment.

Should you be accepted into the SCSC program, your team’s fundraising goal is determined by how many students are on your team multiplied by $500.00.

If you have questions regarding this fundraising pre-training assignment, please refer to the information on the website:

XII.When mailing this application include:

• Your Pre-Fundraising plan of two pages.
• A photograph of yourself, not larger than 3” x 5”, taken within the past year.
• A photo copy of your photo ID to be used for air travel security
• A copy of your valid Health Insurance Card.
• The background check permission if you are over 18 years old.
  (if younger, send as soon as you turn 18)
• Rookies, if you are not including your physical signed by a physician, be sure to write in the date of your appointment. Send your completed physical documentation by February 28th, 2016.
• Make sure all information on this application is complete and accurate.
• Make sure all information listed for references is complete and accurate.

If you have a conflict with the June 15th Onsite SCSC Training arrival date, Do Not submit this application. Call Helen Goodrich with questions. Her cell phone number is 308-219-0053.

The deadline for this application and items 1-6 above is Jan 8, 2016. Applications will be accepted:

Electronically at

Mailed via USPS, the postmark must be January 8, 2016

• SCSC Committee, Helen Goodrich,P.O. Box 164, North Loup, NE 68859

No late applications will be considered.

PRE(Projected) - Fundraising Plan Page 1 of 2

This page MUST accompany page 2 of the Pre Fundraising Plan and your SCSC application. It is a REQUIRED* Pre-training assignment, due by January 8, 2016. After completing these two PRE-planning fundraising pages, make a copy for yourself to keep.

IMPORTANT NOTE:CHECKS SHOULD NOT BE MADE OUT TO YOU PERSONALLY.Advice all potential contributors that checks MUST be made out to “SCSC Support” and are due by May 24th, 2016. No personal names can appear on the check “to” or memo lines in order for the donor to be eligible for tax credit for this charitable donation. Inform potential contributors to include your name on a note Remember, you are raising funds for SCSC and your team for this year – not for yourself or your own transportation or costs. If contributors want to give you a personal money gift to help you with your summer expenses, they can. However, this should not be given during or for an SCSC fundraising event.

All Funds should be sent to:

SCSC SUPPORT, P.O. Box 1678, Janesville, WI 53547-1678

Name of applicant ______

I will personallycontribute to my SCSC team’s fundraising goal by:

Example: …tithe my income from March till June.

1. ______Date ___/___/_____

2. ______Date ___/___/_____

3. ______Date ___/___/_____

The number of letters with preaddressed, stamped envelopes I will send out is ______.

(See the example of the fundraising letter either in your folder, received at conference, or on the website,sdbwomen.org)

My home church, Association, or local Christian Organizationwill help me raise funds by:

Example:…a special offering will be taken.

4. ______Date ___/___/_____

5. ______Date ___/___/_____

6. ______Date ___/___/_____

PRE(Projected) - Fundraising Plan Page 2 of 2

This page MUST accompany page 1 of the PreFundraising Plan and your SCSC application. It is a REQUIRED* Pre-training assignment, due by January 8,2016. After completing these two pre-planning fundraising pages, make a copy for yourself to keep.

IMPORTANT NOTE:CHECKS SHOULD NOT BE MADE OUT TO YOU PERSONALLY. Advice all potential contributors that checks MUST be made out to “SCSC Support” and are due by May 24th, 2016. No personal names can appear on the check “to” or memo lines in order for the donor to be eligible for tax credit for this charitable donation. Inform potential contributors to include your name on a note Remember, you are raising funds for SCSC and your team for this year – not for yourself or your own transportation or costs. If contributors want to give you a personal money gift to help you with your summer expenses, they can. However, this should not be given during or for an SCSC fundraising event.