2017 Application - Greensboro Urban Project

First Name

Last Name

Home Address

Address Line 1

Address Line 2

City

Country

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State/Province

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Zip Code

Email

Phone

Birthday

School Currently Attending

Anticipated Graduation Date

Languages Spoken

Possible Career Goals

Share about your faith walk -- are you currently a Christian, and if so, for how long? What has that walk looked like? If you're unsure of your faith, share about that journey as well.

Why are you interested in joining the Greensboro Urban Project? What do you hope to learn?

Have you had any cross-cultural experiences before? If so, please give a brief description and share about how they've impacted you.

Do you have experience working with children? Please describe.

To what degree are you a risk-taker/initiative-taker?

How do you respond to unexpected changes in programs or activities? Do you like adjusting on the go?

Briefly describe your understanding of and participation in racial reconciliation.

What is your understanding of what it means to be a fully-engaged/committed member of a community? Why is it important?

What are some of your strengths and weaknesses that might be relevant to this project?

Who is your current health insurance provider?

**Note - if you do not currently have insurance, you will be required to subscribe to a short-term plan during the program. Let us know if you need assistance in this area.

Are there any physical or emotional limitations that may require special consideration in your assignment? Are you currently under the care of a physician?If so, explain and provide a name and address. List any prescription medications being taken.

Do you have any food restrictions/allergies we need to be aware of?

Have you attempted suicide in the past three years? If so, please give an update on the care you have received since then.

Emergency Contact Info (please list two emergency contacts)

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Last Name

Email

Phone

Relationship

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Additional important information

Thank you!