Office of Supervised Ministries: Site Application for a Part-time Intern

If your church, institution, or organization is interested in hosting a student intern from Yale Divinity School during the 2013-14 academic year, please complete this form. The information submitted will be made public on our web site for interested students to view March 1, 2013 onward. Deadline for submissions is February 22.

If this is not your first time submitting an application for a student intern, please take note of multiple new questions listed under "Site Information." Namely: Mission Statement, Weekly Schedule, Outreach Programs, and Site Requirements for Interns.

At the bottom of this page is a downloadable file titled "Printable Internship Agreement." Please sign that agreement as part of your application process. Submission instructions are provided on the form.

*If you prefer to submit a hard copy of your application, then you may download that form HERE.

Contact Information

Name of Site:

Website:

Name of Supervisor: *

Supervisor Position:

Supervisor Email Address: *

Supervisor Telephone Number: *

Institutional Address

Street:

City:

State:

Zip code:

Mailing Address for Supervisor (If different from above)

Street:

City:

State:

Zip code:

Additional Supervision

If others will be instructing and supervising the intern, for instance, a theological mentor or a co-supervisor, then please indicate below:

Name of Theological Mentor:

Mentor Position:

Mentor Email Address:

Mentor Telephone Number:

Name of Other Supervisor:

Estimated % of Supervision:

Supervisor Position:

Supervisor Email Address:

Supervisor Telephone Number:

Site Information

Denominational Affiliation, if any:

Mission Statement:

Site Description (Please list some of the salient characteristics of your congregation or constituents.):

What outreach, mission and/or community ministries are active parts of the life of your congregation/chaplaincy/campus ministry/organization?:

Weekly Schedule (List any regular events that are a part of your community’s life together.):

What best describes your church or program?:

Small

Medium

Large

Very Large

Comment:

Is it possible to get to your site without a car (i.e., walking distance, public bus, metro-north train, etc.)? If so, describe what means are available:

If you’re able to assist the student with transportation costs, or if you will provide other aid, please indicate those arrangements here:

If your site is fully or partially handicapped accessible, please indicate that here:

Have you obtained any necessary approvals from a governing body or supervisor in order to host an intern?:

Yes

Do you anticipate having other interns at this site (from other seminaries or programs such as social work, unofficial internships from YDS students, undergraduate interns, etc.)? If so, please describe:

If several students are interested in your site, how many are you willing to interview?:

List any site requirements for interns (background check, medical tests, special training, etc.):

Internship Description

Describe the internship you are offering:

Be as specific as you can about your expectations or, if these are negotiable, the opportunities you can make available. A final, mutually agreed-upon set of responsibilities will be included in the Learning Agreement.

Supervisor Information

Years in current position? :

Years in this type of ministry or work? :

Previous supervision experience:

Please describe your previous training in supervision:

What interests you about mentoring a YDS student?:

Are you ordained?:

Yes

If you are ordained, in what tradition and what year were you ordained?:

Please list any formal or informal theological education you’ve completed (OR attach resume below):

You may attach a resume here:

Attachment	Size
Internship Agreement Page.doc	41.5 KB