Jovenes en Camino
Intern Application
Name (Last):	(First)	(Middle)
Current Address (Street/P.O. Box):
City:	State:	ZIP:
Summer Address (Street/P.O. Box):
City:	State:	ZIP:
Eamil Address:
Birthday (MM/DD/YYYY): Place of Birth:
My Health is: GoodFairPoor If yes, please explain:
Are you currently taking any prescribed medications? YesNo If yes, please explain:
Have you had any serious physical or emotional illnesses within the last five years? YesNo If yes, describe illness:
Do you have medical insurance? YesNo If yes, what is the name and address of your insturance company:
What is your academic educational level?
Are you currently in school? YesNo If yes, where?
What degree(s) have you earned?
Have you had special vocational training?
Have you ever worked as an intern before? YesNo If yes, provide where you worked, contact person, & phone #:
Do you speak Spanish? YesNo
If yes, check level   Non-ProficientBasicProficientVery Proficient
Are you a Christian? YesNo
What church do you attend (Name, City, State)
Have you ever traveled to Honduras before? YesNo If yes, where did you go and why?
Have you ever been to Jovenes en Camino? YesNo
Why would you like to be an intern at Jovenes en Camino?
Date you could begin:(MM/DD/YYYY) Date you would need to return:(MM/DD/YYYY)
You must provide (3) three references. Those you list will be called.
(Preacher/Youth Minister/Elder)Phone Number
(Teacher/Employer)
(Friend/Relative)