Attach photo here

(Returned if required)
2010
STUDENTS IN MISSION

I. BASIC FACTS ABOUT YOURSELF

A. Name____________________________ Preferred/or nickname______________

B. Date of Birth ________________ Place of Birth_________________________

C. Permanent Home Address______________________________________________

Street City
________________________________ Home Phone_______________________
State Zip

D. College/University________________________________Year in School________

E. Complete College Mailing Address_______________________________________

Street City
__________________________ College Phone___________________________
State Zip
F. If attending college, spring semester ends when?____________________________

G. Name and address of your local church____________________________________

Name
____________________________________________________________________
Street City State Zip

H. Email address________________________________________________________

I. Best Way to Contact You_______________________________________________

II. YOUR PAST LIFE

A. In what towns, cities, or areas have you lived?

B. What do you consider to have been your most significant personal achievement during
high school?

C. What has given you the most difficulty during college? (BE VERY SPECIFIC)

D. Briefly describe your activities and responsibilities in your local church and college.
 III. YOUR FUTURE
A. What are your plans for future education and/or career employment? (Give Details)

B. What are your feelings about the future? Do you consider yourself basically optimistic or
pessimistic? Explain your response.

C. Do you intend to apply for other jobs or projects for the summer of 2010?
Circle Yes / No If your answer is “yes”, where would Students In Mission rank in your
order of preference? You may explain if you wish.

D. Are there any factors, such as demanding family situations (long-term illness of family
members), previously made commitments (such as promises to be in a wedding etc.), vacation
plans of your family, high school graduation of a friend or relative which you will attend, or
any such matters which might infringe in any way upon your freedom to totally commit
yourself to the dates of June 10 – July 31, 2010, with possible additional training June 7-9
depending on your site? If so write your response here.
IV. YOUR SELF UNDERSTANDING
A. List all of the specific skills, which you have, giving examples of how you may have
used these skills in the past. (BE VERY SPECIFIC) Examples of skills: playing
piano, carpentry, swimming, teaching, sports activities, specific crafts, etc.

From the above list, tell which skills are your strongest ones, the one you can do best.

B. Write an original essay (50- 75 words), which describes your own concept of
“mission”.

C. In the light of your talents, abilities, aspirations, skills and your own concept of
mission, what type of SIM assignment would be most or least suited to you? Explain.
FYI – sites range from those primarily dealing with construction to those working with
children. All deal with people in need and the church in mission.
V. OTHER INFORMATION
A. Are you in good physical heath?_________ Do you have any physical problems which
would need to be considered in making your assignment in SIM? Explain.

B. Do you have a driver's license?_________ Will you have a car available to use during
the summer?_________ Note: These two questions are for information in making
SIM assignments and in no way have any bearing on your possible acceptance.

C. Please give the names and addresses of the people who will be asked to provide
references for you:

1. Your Pastor_________________________________________________________

________________________________________________

2. An employer or teacher:_______________________________________________

_________________________________________

VI. YOUR RESPONSE OF AVAILABILITY:

If you can declare yourself free from schedule conflicts so as to totally commit
yourself to SIM June 10 – July 31, 2010, with possible additional training June 7-9
depending on your site, please sign here:

Signature_____________________________________

IMPORTANT NOTES:
1. PLEASE INCLUDE A $15 CHECK (NON-REFUNDABLE APPLICATION FEE.)
MAKE CHECKS PAYABLE TO: WINTHROP WESLEY FOUNDATION
2. PLEASE ATTACH RECENT PHOTO TO TOP CORNER OF PAGE 1
3. THEN RETURN THIS FORM AS EARLY AS POSSIBLE, BUT NO LATER THAN
FEBRUARY 26, 2010.

Mail to: Reverend Narcie M. Jeter

Winthrop University
P.O Box 5009
Rock Hill, SC 29733