Internship Application Form

Term

Fields marked with an * are required

REQUESTED TERM: *

January to January
Summer Term — June to August
August to August

INTERVIEW TYPE: *

I would like to visit Koinonia Farm and interview in person.
I cannot visit the farm in advance, but would like to interview for the internship via phone or Skype.

Personal Information Page 1

Fields marked with an * are required

First Name *

Middle Name

Last Name *

Email *

Phone *

Address 1 *

Address 2

City *

Zip / Post Code *

Country *

Personal Information Page 2

Fields marked with an * are required

Birthdate (format: mm/dd/yyyy) *

Gender *

Female
Male

Current Occupation * Help Text

Upload your resumé (optional - pdf files only)

Have you been to Koinonia before? *

Yes
No

How did you hear about Koinonia? *

Will anyone else be coming with you for the internship (i.e. spouse, children)? *

No
Yes

Emergency Contact:

Emergency Contact - First Name *

Emergency Contact - Last Name *

Emergency Contact - Relationship *

Emergency Contact - Phone

Application Questions

Fields marked with an * are required

What is your motivation for applying for the internship program? *

Do you have or have you had any significant physical conditions or special limitations (climate, severe or life threatening allergies, diet, exercise, stamina, eating disorder, depression, prescription medication)? *

No
Yes

Do you drink alcohol? *

No
Yes

Have you ever struggled with alcohol, illegal or prescription drugs? *

No
Yes

Are you receiving or have you ever received treatment for any addiction? *

No
Yes

Are you living with mental illness? *

No
Yes

Are you receiving or have you ever received treatment for mental illness? *

No
Yes

Do you have Post Traumatic Stress Disorder? *

No
Yes

Are you taking any prescription medications for mental or physical health? *

No
Yes

Do you have any dietary conditions, needs, or requests, i.e. vegetarian, vegan, allergic to broccoli, etc.? *

No
Yes

Application Essays

Fields marked with an * are required

Life Experiences: *

Please tell us about yourself, what has happened in your life that has shaped who you are, and what has led you to want to do an internship at Koinonia Farm. Please remark on your work and educational experiences as well as your interests.

Spiritual Journey *

Share about your journey. What have been the major influences and beliefs that have shaped you into who you are today? How do you attend to your spiritual health? What has been the greatest challenge you’ve had to face regarding your religious beliefs?

What are your views on non-violence? *

References

Fields marked with an * are required

After submitting your form, these two references will receive an email asking them to fill out a reference form for you. Please make sure they receive the email, and then fill out the form for you.

Reference 1 - First Name *

Reference 1 - Last Name *

Reference 1 - Relationship *

Reference 1 - Email *

Reference 1 - Phone *

Reference 2 - First Name *

Reference 2 - Last Name *

Reference 2 - Relationship *

Reference 2 - Email *

Reference 2 - Phone *

Remember to follow up with your references and make sure they visit this link: http://www.koinoniafarm.org/references. They will receive an email asking them to do so when you complete this application. Your application will be processed once we have your completed application and both of your references have submitted her/his recommendation for you.

Applicant Agreement

Fields marked with an * are required

Digital Signature (Please enter full name)

To the extent of my knowledge, the information on this application is truthful and accurate. I understand that should my background check reveal evidence of criminal activity and/or child abuse, I will be disqualified from consideration. By means of this release I authorize Koinonia Farm to make inquiries about me. *

Please look over all your answers using the navigation above to make sure you do not need to make any changes. When you are completely finished please press "Finish and Send"

Internship Application Form

Term

Personal Information Page 1

Personal Information Page 2

Application Questions

Application Essays

References

Applicant Agreement

Koinonia Farm

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