Basic Information

First and Last Name

Date

Email Address

Birthdate

Country of Citizenship

Country of Residence

Sex

Cell Phone Number

Permanent Adress

Church and Address

Education

University/College or High School Name

Major

English Language Proficiency

Non-English Speaker
Conversational
Fluent

*Check only 1 box*

Spanish Proficiency

Non-Spanish Speaker
Conversational
Fluent
Bilingual/Biliterate (English + Spanish)

*Check only 1 box*

Desired Timeframe

Availability and Dates

References

First and Last Name

Phone Number

Email Address

Please describe how an internship abroad with New Hope Girls would align with your long term academic and/or career goals? *

What previous exposure, if any, do you have serving internationally? *

You will be stretched physically, emotionally and spiritually. Do you have any concerns about working in such an environment?

What are your strengths and weaknesses?

Do you have Instagram/Facebook/Twitter?

Have you ever been convicted of a criminal offense (except for traffic related violation) or have any criminal charges against you? *

Have you ever been terminated from a paid or volunteer position or been subject to charges of ethical or professional misconduct? *

*If so please explain, if not write "N/A"

Would this internship fulfill a school requirement?

How would you rate yourself on the ability to...

Stay positive under pressure?

Poor
2
3
4
Excellent

*Only Check 1 box*

Proactively reach out to help others?

Poor
2
3
4
Excellent

*Only Check 1 box*

Come up with creative solutions?

Poor
2
3
4
Excellent

*Only Check 1 box*

Handling adversity?

Poor
2
3
4
Excellent

*Only Check 1 box*

Briefly share your testimony

What is God currently teaching you?

How have you been challenged in the last 6 months?

How did you hear about New Hope Girls?

What area(s) in our program interest you the most and why?

Any questions or comments?

I am overall a healthy person

Strongly Disagree
Disagree
Nuetural
Agree
Strongly Agree

I am happy with my family relationships

Strongly Disagree
Disagree
Nuetural
Agree
Strongly Agree

I have people I can talk to when I am happy or discouraged

Strongly Disagree
Disagree
Nuetural
Agree
Strongly Agree

During the past year, how much trouble have you had sleeping?

Some
A little
A lot

During the past year, how much trouble have you had with getting tired easily and/or low energy?

Some
A little
A lot

During the past year, how much trouble have you had with difficulty concentrating?

Some
A little
A lot

During the past year, have you been under the care of a medical professional for any reason?

*If yes, please explain. (If no, type "N/A".)*

Please list any prescription medication you take regularly and the reason you take it.

*If yes, please explain. (If no, type "N/A".)*

Please explain any special dietary restriction, needs, or food allergies.

*If yes, please explain. (If no, type "N/A".)*

Do you have any other health concerns of which we should be aware?

*If yes, please explain. (If no, type "N/A".)*

THANK YOU!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon! Have a great day!

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

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