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CMIT Program Application
Step
1
of
6
0%
A non-refundable application fee of $100 must accompany this application. Should your application and program be approved this fee will satisfy your first year’s program fee with national approval as a CMIT program. (Pay
here
.)
Personal Information
Name
*
First
Middle
Last
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Cell Phone
*
Email
*
Age
*
Marital Status
*
Single
Engaged
Married
Provide information if you have been if you have been separated, divorced, remarried, or widowed.
Fiancé/Fiancée Name
*
First
Last
Spouse Name
*
First
Last
Wedding Anniversary
*
MM slash DD slash YYYY
Educational Background
College/University Name for Highest Degree Earned
*
Please write out the full name of the college/university. Abbreviations are not clear enough to determine the name as there can be several colleges/universities with the same acronym.
College/University Location
*
City
State / Province / Region
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Dates Attended College/University
*
Degree Acquired
*
Associate Degree
Bachelor's Degree
Graduate or Professional Degree
Doctoral Degree
Degree in Progress
GPA
*
Ministry/Ministerial Background
Do you currently hold ministerial credentials with the Assemblies of God?
*
Yes
No
What date and where did you receive your ministerial credentials?
*
Credentials
Date
District
What district council presently holds your ministerial credentials?
*
Would you be willing to apply for ministerial credentials?
*
Yes
No
Describe when and where you were converted to Christ.
*
Have you been baptized in water by immersion?
*
Yes
No
Have you received the Baptism in the Holy Spirit with the evidence of speaking in tongues?
*
Yes
No
What biblical and theological education have you had to date (formal and informal)?
*
List five books and/or periodicals you read recently that made an impression on you.
*
Title
Author
Campus Missionary Finances
Do you give full-time focus to campus ministry (no outside employment)?
*
Yes
No
Please describe type of outside job and number of hours per week.
*
Is your personal missionary budget fully raised?
*
Yes
No
What is your total financial compensation for ministry (including benefits, not including outside employment)?
*
Please enter the amount in dollars.
Who determined or set this budget?
*
First
Last
Is your personal missionary budget adequate and appropriate (according to your estimation)?
*
Yes
No
The Local Chi Alpha Campus Ministry
Campus Name
*
Please write out the full name of the college/university. Abbreviations are not clear enough to determine the name as there can be several colleges/universities with the same acronym.
How long has this Chi Alpha campus ministry been in existence and nationally chartered with Chi Alpha?
*
How many total students are involved in discipleship groups in your campus ministry?
*
Use the past semester/quarter as a guide.
How many total students attend the main weekly meeting?
*
Does your Chi Alpha actively participate in mission trips?
*
Yes
No
Essay Questions/Responses
How long have you been involved in campus ministry at the staff level? Do not include years as a student leader.
*
Are you in agreement and compliance with the Statements of Vision, Mission, Faith, Relationship, and Financial Responsibility as articulated on the Chi Alpha Leader Affiliation form?
*
Yes
No
Do you give half tithes to nationally Chi Alpha personally?
*
Yes
No
Does your group contribute to the national Chi Alpha program?
*
Yes
No
How much has been given in tithes and group contributions over the past year?
*
Describe how you participate in district, regional, and national Chi Alpha events.
*
Describe how you were mentored and what evidence of mentoring skills you possess.
*
Did you successfully complete a national approved CMIT program? If so, when and where and under whom? If never, how were you trained in campus missions?
*
What is your process or system for discipleship student leadership development?
How is your local Chi Alpha campus ministry implementing the four priorities of Chi Alpha: healthy leaders, Holy Spirit Empowerment, cross cultural missions & disciple making groups?
Why do you desire to offer a nationally approved CMIT program? How would a CMIT program under your direction contribute to the national Chi Alpha campus ministry vision?
*
What impact on your present Chi Alpha campus group do you anticipate the addition of a CMIT program will have?
*
List other campus ministry staff person(s) who work alongside you. Describe in detail their status according to full-time and/or part-time. Also identify their primary areas of responsibility. How are they compensated, and how much is their total compensation? Which of these will be directly involved in providing leadership in a CMIT program?
*
Describe your personal outreach and ministry to international students. How is your campus ministry involved with them? How many were involved with your group this past semester/quarter? How many international students attend your college/ university?
*
Describe how you relate to the Assemblies of God on the local level and district level. Do you annually affiliate as a missionary leader with national Chi Alpha Campus Ministries, U.S.A?
*
References
District Chi Alpha Director or Representative
*
First
Last
District Chi Alpha Director or Representative Email
*
Chi Alpha Area Director
*
First
Last
Chi Alpha Area Director Email
*
Local Senior Pastor of the Church You Attend
*
First
Last
Local Senior Pastor Email
*
Primary Student Leader
*
First
Last
Student Leader Email
*
Additional Primary Student Leader
*
First
Last
Student Leader Email
*
Your next reference may be either a District Superintendent, District U.S. Missions Director, or District Youth Director. Please select one.
*
District Superintendent
District U.S. Missions Director
District Youth Director
District Superintendent
*
First
Last
District Superintendent Email
*
District U.S. Missions Director
*
First
Last
District U.S. Missions Director Email
*
District Youth Director
*
First
Last
District Youth Director Email
*
A non-refundable application fee of $100 must accompany this application. Should your application and program be approved this fee will satisfy your first year’s program fee with national approval as a CMIT program. (Pay
here
.)
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