Chi Alpha Missionary Associate Spouse Application

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Step 1 of 7

Role
Do you fully subscribe to the National Chi Alpha vision and beliefs statements?*
Vision Statement: We are a Spirit-empowered, diverse community of believers on university campuses, declaring in word and lifestyle our faith in Jesus Christ, equipped to fulfill our purpose in God's global plan.

Statement of Beliefs:
1. We believe the Bible is God’s message to us, so we seek to understand and obey its truth.
2. We believe there is one God who is three persons, so we yearn to know Him in all of His complexity and beauty.
3. We believe Jesus is fully God and fully human, so we rejoice that Christ can be a bridge between us and God.
4. We believe people throughout history have sinned against God, so we are deeply aware that we too are marked by willful disobedience.
5. We believe God extends forgiveness to us through Christ, so we repent and rejoice in our forgiveness.
6. We believe God offers freedom from sin’s grasp, so we live lives that are pleasing to God.
7. We believe followers of Jesus must be empowered by the Holy Spirit, so we expect supernatural power in our daily lives.
8. We believe that God can heal both the body and the heart, so we pray with faith and hope.
9. We believe a mark of surrender to the Holy Spirit is speaking in tongues, so we pray that God would grant us this supernatural gift.
10. We believe in the Church, so we live in this community of faith, inviting others to join us.
11. We believe God gives leaders as gifts to His Church, so we serve those whom the Lord entrusts to us.
12. We believe God commands his followers to celebrate communion and baptism, so we practice these symbolic actions, reflecting on their significance.
13. We believe Jesus will return to claim His Church, so we live in expectancy of His coming.
14. We believe Christ will one day be seen clearly as King on earth, so we live as citizens of His Kingdom now.
15. We believe God is the ultimate Judge, so we live knowing that our choices will echo through eternity.
16. We believe we will live with God forever, so we live with hope regardless of our circumstances.
For more details, see the 16 Fundamental Truths of the Assemblies of God.
- Yes
- No
Will you be participating in ministry with your spouse?*
We ask for all spouses to affiliate if they are involved with students in any capacity.
In what role will you be serving?*
The 2021-2022 CMIT application is closed. The 2022-2023 application will be open in November.
Will you be full-time or part-time?*
What is your title?*
Assemblies of God District Where You Plan to Serve*
You will find the Chi Alpha district map listed here for your reference.
Chi Alpha Area Where You Plan to Serve*
You will find the Chi Alpha district and area map here for your reference.
On what campus do you plan to serve?*
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.

If this does not apply, put N/A.
Do you serve on a campus in addition to your national, area, or district role? If so, please provide the name of the campus.*
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.

If this does not apply, put N/A.
Name of the Supervising Campus Missionary Where You Plan to Serve*
First Last
Email of the Supervising Campus Missionary Where You Plan to Serve*
When do you anticipate beginning ministry?*
What is your primary motivation to serve in Chi Alpha?*
CMIT Program Placement
Please read these instructions before you continue.
A CMIT is approved nationally and locally. Chi Alpha will notify you when you have received national program approval and local site acceptance into the program. Please prioritize your choice of local programs with #1 being your first choice and make sure all your choices are different. These programs are listed online here. Every local CMIT program maintains the prerogative to accept or not accept any nationally approved CMIT.

A nationally approved CMIT should attend the Reach the University Institute (RUI) prior to their CMIT internship. RUI serves as an orientation to the interning year.

This application is for those wishing to complete a CMIT during the 2021-2022 academic year. The following must be included with this application:
- Application Fee Payment: Non-refundable $100 application fee and $75 late fee if submitted after the February 20 deadline (please pay here)
- Recent high-quality professional-looking photo to be used for our online directory
- Copy of the front of your Social Security card and the front of your driver's license
Applications without these items will not be processed.
First Choice*
Second Choice*
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Please choose all different programs. First, second, and third choices cannot be the same.
Third Choice*
How do your parents/guardians view your intentions to become a CMIT? Please explain.*
What will you do next year if you are not accepted as a CMIT?*

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Missionary Account Information
Do you or your spouse/fiancé(e) currently have an Assemblies of God World Missions (AGWM) account?*
Where are you currently serving?*
If you are serving in a sensitive country, you do not need to give the country name and can provide something such as "N/A."
When would you like to transfer your AGWM account to AGUSM?*
Do you already have a U.S. Missions Account?*
What is your account number?*
Do you desire a U.S. Missions account to process your missionary funds?*
If both you and your spouse are applying, only one can be the account-holder.
Please specify.*
What system are you or will you process your funds through?*
Direct Deposit Information
The following information is needed in setting up a U.S. Missions account.
Bank Name*
Bank Address*
Street Address Address Line 2 City State ZIP Code
Bank Phone*
Please provide the number of the local branch.
Bank Account Number*
Bank Routing Number*
I want this to go to a savings account.*
- Yes
- No
I-9 Information
The following information is needed to identify your status as a United States citizen, noncitizen national, a lawful permanent resident, or an alien authorized to work for your U.S. Missions account should you be accepted.
First Name*
First
Middle Initial*
Middle Initial
Last Name*
Last
Please select your current status.*
- A citizen of the United States
- A noncitizen national of the United States
- A lawful permanent resident
- An alien authorized to work
Country of Citizenship*
Country
Do you have a Green Card? If so, what type do you have?*
What is your Alien Registration Number/USCIS Number?*
Please provide the expiration date as mm/dd/yyyy (Example: 03/01/2025) if you authorized to work until a particular date, or if it does not apply, type N/A.*
Aliens authorized to work must provide only one of the following document numbers: An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number. Which of these would you like to provide?*
Alien Registration Number/USCIS Number*
Form I-94 Admission Number*
Foreign Passport Number*
Country of Issuance
Financial Summary
Do you have debt?*
- Yes
- No
Hidden
Do you and your spouse have consumer debt? (HIDDEN- delete for 2022-2023 application)*
Hidden
Please explain the debt and how much you owe. HIDDEN- delete for 2022-2023 application)*
Do you and your spouse have school/student loans?*
Are you and your spouse's school debt/loans higher than $60,000 combined?*
Hidden
Please specify the amount of school debt you and your spouse have. HIDDEN- delete for 2022-2023 application)*
Are you planning on deferring the school debt/student loans?*
Do you have consumer debt (e.g., credit cards)?*
Are your and your spouse's consumer debt higher than $60,000 combined?*
Please explain your plan to pay off your debts.*

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Formal Education
What is the highest degree you have earned?*
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
Area of Study*
GPA*
Please enter a number from 0 to 5.
Dates Attended College/University*
Graduation Date*
Occupational Background
List specialized experience, skills, and training.
Click the button on the right to add rows.
List Current and/or Previous Employments for the Past Five Years*
Click the button on the right to add rows.
Name of Employer City/State of Business Dates Employed Job Title Job Responsibilities Reason for Leaving
Have you ever been discharged or asked to resign from an employment or ministry position?*
- Yes
- No
Please explain.*
Personal History
List any serious illnesses, emotional difficulties, learning disabilities, problems of substance abuse that you, your spouse/fiancé/fiancée, or your children (if applicable) have now or had in the past.
Describe how you respond emotionally to stress, time pressures, and expectations others place on you.*
How do you normally respond to and express anger?*
Have you ever been convicted of a crime?*
- Yes
- No
Please explain.*
What is your sexual orientation and/or identity?*
- Heterosexual
- Homosexual
- Bisexual
- Transgender
- Other
Other*
Self Evaluation
Please complete the scale below by rating yourself.
I have a long-term commitment to campus missions.*
I have a consistent devotional time.*
I operate in the spiritual gifts.*
I am a person who lives well under authority.*
I am a leader people willingly/voluntarily follow.*
I am creative and innovative.*
I am a person of energy.*
I manage stress well.*
I am a team player and network with others easily.*
I am sensitive to the ideas and feelings of others.*
I have good communication skills.*
I am an open, transparent person.*
List your primary personal character strengths.*

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References for CMIT Applicant
Please have the following three people fill out a character reference on you:
- Your campus director (or home church pastor if you have no campus director)
- Another person who knows you well who also holds a position of ministry leadership
- A third reference who is not a relative
Your references will be sent an automatic email with the link to the reference form.
References have until May 1 to submit their reference. These references are to be confidential.
Campus Director Name*
First Last
Campus Director Phone*
Campus Director Email*
Another Ministry Leader Name*
First Last
Another Ministry Leader Email*
Another Ministry Leader Phone*
Position and/or Relationship to Another Ministry Leader*
Third Reference Name*
This reference can NOT be a relative.
First Last
Third Reference Email*
Third Reference Phone*
Position and/or Relationship to Third Reference*
References for Chi Alpha Missionary
As a benefit of affiliating with Chi Alpha Campus Ministries, U.S.A., we are providing liability insurance coverage for each of our chartered groups. One of the requirements for this coverage is that we collect credible references who have observed you in ministry and are not related to you. Please provide three names and emails below, which will automatically be sent a document that can be electronically signed. Your affiliation process will not be completed without these personal references, so please follow up to make sure that this process is fully complete. These references are only required once and not on an annual basis.
Reference #1 Name*
First Last
Reference #1 Email*
Reference #2 Name*
First Last
Reference #2 Email*
Reference #3 Name*
First Last
Reference #3 Email*

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Uploads
Upload Photo*
Please upload your recent high-quality professional-looking photo to be used for our online directory as a jpg file.

Once uploaded, the file name will appear with an icon of red circle with an X inside it. This icon is not an error and allows you to delete the file if needed.
Accepted file types: jpg, jpeg, Max. file size: 300 MB.
Was the photo you uploaded taken by a professional photographer?*
Do you have permission from the photographer to use this photo?*
Social Security Number*
This is required for the background check. Please enter as XXX-XX-XXXX (123-45-6789) with dashes in between.
Upload Copy of the Front of Your Social Security Card*
Please upload a copy of the front of your social security card to be used for your background check.

Once uploaded, the file name will appear with an icon of red circle with an X inside it. This icon is not an error and allows you to delete the file if needed.
Accepted file types: jpg, jpeg, gif, png, pdf, tiff, Max. file size: 300 MB.
Upload Copy of the Front of Your Driver's License*
Please upload a copy of the front of your driver's license to be used for your background check.

Once uploaded, the file name will appear with an icon of red circle with an X inside it. This icon is not an error and allows you to delete the file if needed.
Accepted file types: jpg, jpeg, gif, png, pdf, tiff, Max. file size: 300 MB.
Important!
Please download this Assumption of Risk. This document requires your signature as well as the signature from a witness (other than your spouse if you are married). You have the following options to sign this document:
- Download Acrobat Adobe Reader DC, create a digital ID, and digitally sign the document. The program will automatically add the date and timestamp, which makes the signature legal. A digital signature without one is not valid.
- Print out the document and physically have the document signed. You will need to scan or take a clear photo of the signed document in order to upload.
Once signed, upload the signed form via the upload box below.

You may save and continue the application if needed to acquire the signatures.
Upload Signed Assumption of Risk*
Once uploaded, the file name will appear with an icon of red circle with an X inside it. This icon is not an error and allows you to delete the file if needed.
Accepted file types: jpg, jpeg, gif, png, pdf, tiff, Max. file size: 300 MB.
Please pay the non-refundable $100 application fee and $75 late fee if submitted after the February 15 deadline (pay here).
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Chi Alpha Missionary Associate Spouse Application

Step 1 of 7

Your Personal Information

Children

Emergency Contact

Role

The 2021-2022 CMIT application is closed. The 2022-2023 application will be open in November.

CMIT Program Placement

Please read these instructions before you continue.

Application Fee Payment: Non-refundable $100 application fee and $75 late fee if submitted after the February 20 deadline (please pay here)

Missionary Account Information

Direct Deposit Information

I-9 Information

Financial Summary

Formal Education

Occupational Background

Personal History

Self Evaluation

Your Beliefs

Spiritual History

Ministry Background

Church Affiliation

References for CMIT Applicant

Your references will be sent an automatic email with the link to the reference form.

References for Chi Alpha Missionary

Uploads

Important!

Find A Chi Alpha Group Near You

Name of Employer	City/State of Business	Dates Employed	Job Title	Job Responsibilities	Reason for Leaving

Title	Author

Credentials	Date	Assemblies of God District