2018 ENGLISH CAMP PROGRAM APPLICATION FOR RETURNING STUDENTS

Transcription

1 2018 ENGLISH CAMP PROGRAM APPLICATION FOR RETURNING STUDENTS PHOTO REQUIRED Dallas Baptist University is offering a practicum teaching English in Beijing, China for 3-4 weeks in July. Actual trip dates will be released later. All participants will receive training and orientation at DBU in June as part of the requirements for the practicum course. All participants must obtain a valid U.S. passport and have at least six months of validity from the time of return to the U.S. DBU will process the visa application. Participants will also be required to purchase medical insurance for overseas travel and acquire all needed immunizations prior to departure. The deadline to apply is February 28, Completed applications with all required documents are to be turned in to Todd Oriarte in the Moon International Center. Participants are responsible for references being turned in on time. In addition, immediately after acceptance, a $250 deposit will be required. This deposit is refundable upon successful completion of the program, unless there is an outstanding balance on the student s account or if the student withdraws from the program before April 7, 2018 (Immediate family or medical emergencies are an exception). An interview will be scheduled upon application completion. A. PERSONAL INFORMATION (PLEASE PRINT) Name: Last First DBU Student ID# D.O.B.: Sex Age Date of Birth Middle (Not initial): / / mm/ dd /yy Marital Status: Single (never married) Engaged: Wedding date Married Separated or divorced Current Mailing Address: Street: City: State: Zip Code: Preferred Address: DBU Address: Permanent / Parents Mailing Address Street: City: State: Zip Code: Parents address: Parents Phone #: ( ) Phone # ( ) Cell Phone # ( ) Country of Citizenship: If not a U.S. citizen, then are you a permanent resident? YES NO If not born in the U.S., what year did you move to the U.S.? Passport Number: Country: Expiration Date: Are you a native English speaker? Y N Are you a full-time DBU student/employee? Y N How did you hear about the program? B. Emergency Contact Name: Last First Relationship: Please check one Parent/Guardian Sibling Friend Address: (If different than above) Street: City: State: Zip Code: Preferred Address: Other (Please list) (If different than above) Home ( ) Cell ( )

2 C. Church Membership Local Church Membership City State Are you a member and for how long? Pastor s Name: Level of Relationship: Casual Well Very Well Denominational Affiliation: Do you attend church on a weekly basis? No Yes Years: No Yes Local Church Phone #: Other minister that knows you ( ) well: If you are not a member of the church you attend while in college, where is your membership? Home Church (if different from above) City State Pastor s Name: Church Phone #: ( ) Activities in home and/or local church D. EDUCATION Check your classification at the end of the Spring 2018 term: Freshman Sophomore Junior Senior Graduate Total hours completed by May 2018 GPA: Major: hrs. Minor: How many semesters have you been at DBU? Vocational choice Other Colleges, Universities, or Seminaries Attended (Attach additional sheet if needed) Name: No. Hours/Degree Major: E. DBU EXPERIENCE Projected Date of Graduation: Payment History Current Balance: Payments on time: Y N In good standing: Y N Desired Degree: Since attending DBU you have lived: On campus: Y N Length of Time: _ RA: Off campus: Y N Length of Time: Roommate: If there have been any conflicts with Student Affairs or Residence Life within the past 12 months, please explain. List any academic honors/awards received within the past 12 months. List any organizational involvement and positions held within the past 12 months. List any BSM involvement or other DBU ministry involvement within the past 12 months. Briefly summarize your educational, social, and spiritual experiences at DBU since applying last year. Briefly describe your future goals in terms of occupation. Where do you see yourself in five years?

3 F. HEALTH INFORMATION My health is: Excellent Good Fair Poor Are you currently on any medication? YES NO If so, give name and reason. Include OTC medications. Are you under the care of a physician due to physical or mental conditions which may limit your ability to serve in some assignments? YES NO If yes, please explain: Have you ever been under psychiatric care? Yes No If yes, please explain on a separate sheet of paper. Do you drink alcohol, smoke, or use any kind of tobacco products? Yes No If so, please explain on a separate sheet of paper. Insurance Name: Policy Number: Group ID: Expiration Date: Policy Holder: G. TEAMWORK Would other adults say you work well with others? Why or why not? How often do you find yourself in conflict with others? Explain. Are you willing to follow policies and leadership decisions even though you might not agree with a decision? Yes No If no, then please explain: H. REFERENCES Please list the name, address, and phone number of references below. (Please do not use family members) Reference Name Phone 1. Pastor or Church Staff Member 2. DBU Faculty or Full- Time Staff 3. Work Supervisor 4. RD/RA (if never in a dorm, substitute another DBU faculty or staff) 5. Roommate (if never with a roommate, substitute a co-worker) I. TEACHING, EVANGELISM, AND CULTURAL EXPERIENCE 1. What are some offices/positions you have held, projects you have completed, or experiences you have had within the past 12 months that have helped you to develop a sense of responsibility and leadership? Please explain. 2. Briefly describe any cross-cultural experiences you have had since applying last year.

4 3. List all experiences and training you have had related to evangelism within the past 12 months. 4. List all experiences and training you have had related to teaching within the past 12 months. J. TALENTS, ABILITIES, AND MINISTRY EXPERIENCE Have you served in student missions since last year s trip? Y N Type of ministry: Place: Length of time: Indicate experience in the following: Novice (Nov.), Intermediate (Int.), Extensive (Ext.) Nov. Int. Ext. Nov. Int. Ext. Nov. Int. Ext. VBS/Camp Evangelism Song Leading Recreation Drama/Puppets Bible Teaching Share Testimony Teaching ESL Youth Ministry Please describe other experiences you feel may be helpful: ANY INSTRUMENTS PLAYED Indicate skill level: Beginner, Intermediate, Advanced Guitar Piano Other: Please list LANGUAGES / PROFICIENCY LEVEL (other than English) Read Write Speak Some Fluent K. WORK EXPERIENCE Please provide a list of all your employers for the past two years (Beginning with the most recent job).

5 L. EXPRESSION OF CHRISTIAN FAITH Please limit your answers to the space allowed. 1. Briefly describe how God has changed your perspective on missions and Christianity since last year. How has this experience and a continuing relationship with Christ affected your life?. 2. Since last year s trip, have you had the opportunity to share your faith with a non-believer? If applicable, describe a recent experience of sharing your faith with someone who was not a Christian. 3. State your reason(s) for wanting to minister again as a teacher in the DBU English Camp Program.

6 M. POLICY AGREEMENT FOR PARTICIPANTS OF DBU SUMMER ENGLISH PROGRAM Alcohol/Drug/Tobacco Use Participant agrees to abstain from any use, promotion, or transport of alcoholic beverages, drugs, and tobacco for the duration of the trip. Failure to adhere to this policy will result in immediate dismissal and return to the U.S. in which participant will be financially responsible for airfare/travel expenses and will be required to meet with the Dean of Student Affairs upon return. /Communication Participant agrees to follow guidelines specific to the site. Wording must be guarded to avoid harm to other participants and site hosts. Attire Participant is a representative of DBU and a model for Christianity. Therefore, the participant's attire must be business casual during teaching hours. Financial Responsibility Participant will provide a $250 deposit upon acceptance. Participant is responsible for paying for passport, visa, travel insurance, any needed immunizations, class tuition, and personal expenses. Flight, room and board, weekend activities, and most meals are free for the participant. If a participant cancels, then he/she is responsible for any and all financial expenses incurred except in the case of a major medical or family emergency. Participant is responsible for expenses due to the dismissal and removal from the program. The deposit will not be returned if an outstanding balance is on the student s account or if the student withdraws for the program after April 7, 2018 (Immediate family or medical emergencies are an exception). Training Responsibility Participant will register for the three-hour credit upper-level course, Practicum in Cross Cultural Perspectives (Long Summer term) and attend training prior to trip departure. Schedule and class will be announced at a later date. Exclusive Relationship Dating, getting engaged, and the forming of exclusive relationships are not allowed while on the trip. Trips Home Trips home are not allowed except for emergencies within the immediate family. The participant must inform the team director and the DBU camp coordinator if an emergency arises requiring a trip home. Trips will be made at the participant s expense. Family Visits If a family member plans to visit the participant while overseas, the participant must obtain approval from the team director prior to the visit. Also, it is vital that any visits from family do not interfere with teaching duties or responsibilities. Questionable Conduct The participant must seek to avoid all inappropriate behavior, including anything that would hinder his/her ministry or DBU s ministry during the term of service. BY SIGNING BELOW, I CONFIRM: I have read and agree to comply with all the above policies. I understand that if I choose not to adhere to any of these policies it could lead to my dismissal from the program. I understand that if I am dismissed from the program while overseas, I am responsible for all expenses incurred for my early return to the USA. I have completed all of the application questions to the best of my ability, and I guarantee the information is true and accurate. Printed Name: Date: Signature: Witness: