GoConnect Trips& Internships

Placement Application

Each of the trip and internship opportunities Kontaktmission offers is designed for people at a particular point in their development as potential missionaries. Your answers to the questions on this form will help us determine where, and on what kind of trip, to place you.An experience in a foreign country can be thrilling and life-changing in positive ways, and it can also be very difficult and personally challenging and even troubling. We, like you, want to glorify God with this trip, and we want to be sure to help you get exactly the kind of trip and experience you need.

There are no right or wrong answers,just helpful ones!

Your responsesand personal information will be kept strictly confidential.

General Information

Name______Date______

Address______

City______State_____Zip______

Email______

Primary telephone______Is this a mobile phone? Yes / No(circle one)

Other telephone ______Is this a mobile phone? Yes / No

Interested in what country/-ies? ______

Applying for: GoConnect Trip / Internship / Beginning Service with KM

(Circle one; applying does not guarantee placement. GoConnect Trips may also require onlineregistration)

Education and EmploymentInformation

Date of birth ______Years left in college (if applicable) ______

College name ______Major______

Is an internship required for your degree program? Yes / No #credit hours for this ______

Highest year/degree of education completed______

Career goal______

Current employer/job______

Marital status ______How many children?____ Ages______

Citizen of what country______

Foreign languages in which you are fluent______

Foreign languages in which you have some ability______

Number of years of education (or daily experience) in best foreign language______

Readiness Questions (Please also complete the “Missionary Service Readiness” questionnaire.)

1. Would close relatives (especially parents) support your decision to take a trip? Yes / No

2. How sure are you that you wish to be a long-term missionary? Very / fairly / not sure

3. If you answered “very sure” or “fairly sure”, please write in your own words why you wish to serve as a missionary: ______

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4. Please explain why you wish to take a trip or do an internship:______

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5. What is the longest period of time you have been away from your own bed? ______

6. What do you consider to be your greatest personal strengths?______

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7. What do you consider to be your greatest personal weaknesses? ______

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8. Would people close to you agree with your answers to 6 & 7, or how might they answer?

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9. Do you prefer to work by yourself on projects, or in a team with others? ______

Please explain your reason for this answer.______

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10. If you are a student, please provide us with a name of a faculty reference at school we may contact about the possibility of your serving on a short-term trip or internship. If you are not a student, please provide a pastor’s name and the name and location of the church. Name/position:______

Contact phone or e-mail address:______

11. What are your highest hopes for this experience? ______

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12. Please tell us about any medical conditions that may affect your experience or where we place you. Examples of these include allergies (pollen, animals, food, medicine), diabetes, physical limitations, etc. ______

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13. Please tell us about any psychological difficulties or traumatic life situations you deal with which may affect your response to a stressful situation involving such problems as difficult people, strange surroundings, uncertainty, etc. Examples are childhood abuse, mental illness, and current stressful home situations. ______

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14. Have you undergone counseling/therapy for emotional or psychological issues? Yes/No

Signature ______Date______

Please email completed form as an attachment to Thank You!