Break the Grey

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You are about to embark on the greatest journey of your life! 
 
This application requires:
 
  • High School Diploma or GED
  • Contact and family information
  • Educational history
  • Payment processing fee of $25
 
SAT/ACT are not required to apply for BTG Internship
 
Questions? Call Anna Pranger at 260-409-8321 or email @ interndirectorbtg@gmail.com
 
The information in the FIRST section is requested to comply with federal guidelines and will not be used to determine admission status
 
* Denotes a required field to fill in

SECTION 1:

First Name*
Last Name*
Email*
Verify Email*
Phone Number*
Date of Birth:  DD/MM/YYYY*
Personal Facebook Link*
Instagram Handle*

Address*
Address Line 1 
Address Line 2 
City     State     Zip 
Country*

Gender*
Male
Female
Marital Status*

U.S Citizenship *
Yes
No
If you are not a U.S Citizen, please tell where you are from?

Ethnic Orgin*

Are you a veterans dependent?*
Yes
No

Are you in the National Guard or Reserves?*
Yes
No

Will you be receiveing VA benefits?*
Yes
No

SECTION 2:

Which internship session are you applying for?*
August 2019-May 2020
August 2020-May 2021

Date of salvation?  mm/dd/yyyy*

Have you been baptized in water?*
Yes
No
If yes, when?

Home church?*
Youth Pastor/Leaders name?
Senior Pastor's name?
List any ministries you are/have been involved with?

Reference 1 name, Address, Relationship, & Phone Number? *
Reference 2 name, Address, Relationship, & Phone Number? *
Reference 3 name, Address, Relationship, & Phone Number? *

Last High School Attended*
Type of School*

Graduated?*
Yes
No
If yes, when?  mm/dd/yyyy
If no, anticipated graduation date?  mm/dd/yyyy

Do you have a GED?*
Yes
No
Are you or have you ever been under an IEP(Individual Educational Plan) or a 504? Please attach in email and send to interndirectorbtg@gmail.com. The contents of the form will remain confidential.*
Yes
No

ACT or SAT score?*
If you haven't taken one, do you plan to?*
Yes
No
List any school honors, awards, and accomplishments

Are you employed?*
Yes
No
Present Employer
Position
Hired When?
Past Employer
Position
Hired When?
Reason for leaving?

Father's Name*
Father's Address*
Father's Phone Number*
Father's Occupation*
Accepted Christ?*
Yes
No

Mother's Name*
Mother's Address*
Mother's Phone Number*
Mother's Occupation*
Accepted Christ?*
Yes
No

How do you plan to pay your internship tuiton of $6,000?*
Do you own your own vehicle?*
Yes
No

How would you describe your health?*
List any allergies you may have
List any physical limitations
List any current medication you currently use
List any other physical problems or ailments

SECTION 3:

Have you used illegal drugs?*
Yes
No
Date of last use?  mm/dd/yyyy

Tobacco Use?*
Yes
No
Date of last use?  mm/dd/yyyy

Alcohol use?*
Yes
No
Date of last use?  mm/dd/yyyy

If you have been charged or convicted with a felony please explain below
Have you ever been involved in satanic worship or other occult practices?*
Yes
No
If so, please explain?

Fighting *
Fearfulness*
Insomnia *
Inability to concentrate*
Laziness/Lack of motivation*
Lying*
Learning Disablities *
Nervous Disorders*
Pornography*
Problems with socal relationships*
Problems with parents*
Night terrors*
Reading comprehension*
Sadness *
Stress*
Sexually promiscuous lifestyle*
Suicide attempts *
Theft *
Thoughts of suicide*
Trouble making decisions *
Unstable job record*
Participated in non traditional marriage(without a marriage license)*
Trouble listening to authority figures*

If you answered "Past Issue" or "Current Issue" above please explain to the best of your ability what you have come to learn about the issues you faced.*

In the space provided, please give us a little of your backround(minimum of 250 words please)*

I THE ABOVE APPLICANT GIVE MY APPROVAL.


Acceptance:* 
Full Name:* 
You have reached the end of your application process. To complete this application you will be directed to a $25 application processing fee page. Click the submit button to continue.
 
If Break the Grey refuses your application, applicants will be offered a refund.