Your Full Name
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First Name
Last Name
Phone
(###)
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Email Address
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Program Dates
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When are you considering serving with us?
What areas of ministry are you most interested in?
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Please check up to 3 options.
How did you hear about our program? Why do you want to participate?
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Describe your relationship with Jesus and how it impacts your daily life.
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Feel free to share your testimony or any faith significant moment.
Everything we do points to Jesus. We create immersive experiences because we want to point all sorts of people to Jesus. We seek to restore relationships, love others and serve because Jesus set that example for us. We seek to serve every part of the body of Christ. We want to emphasize that while you are serving with Border Perspective, you may be exposed to Christian practices, theological, doctrinal and spiritual beliefs from our community partners and church partners which could be very different from yours.
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Tell us about your faith background (denomination).
Describe your relationships with your family while growing up and now. How have the dynamics of your family impacted you? What is family life like for you?
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Tell us about your family and about your experiences with school, church, travel, friends, family dynamic etc.
Professional Reference
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First Name
Last Name
Professional Reference Email
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Phone
*
(###)
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Ministry Reference
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First Name
Last Name
Ministry Reference Email
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Phone 1
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(###)
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Personal Reference
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First Name
Last Name
Personal Reference Email
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Phone 2
*
(###)
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Have you ever been arrested or convicted of a crime?
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Have you been diagnosed with a mental illness ?
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Example: Anxiety, Depression, Bipolar, Schizophrenia, Borderline Personality Disorder, Other
Have you harmed yourself in any way?
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Example: Eating Disorder, Self-harm, Suicidal Thoughts/Attempts, Substance Abuse
Explanation: If you checked past or present for any of the above, please give further explanation for each. No need for extensive details, just provide the highlights. Please note if it was a one time event or an ongoing activity, last date of occurrence, timeline of counseling, etc. These are helpful details for us to best understand your story and experiences.
Please list all medical conditions/diagnosis.
List any major diagnosis in the last 10 years (Include year of diagnosis).
List any other conditions we should be aware of.
Medications
Please complete all 3 of the following about medications you are currently taking and may be taking while on your residency.
List all prescription medications you will bring.
List the condition for which each medication is required.
List any side effects you experience while taking each medication.
Allergies
Please list any known allergies that would require medical attention and/or an Epi-Pen.
Please list any known allergies that would cause a non-emergent reaction.
