CMIT application checklist
Please make sure you have all of the following documents when sending in your
Campus Missionary-In-Training application:
$30.00 Application processing fee
Completed application with signatures from campus pastor
Completed spouse application (if applicable)
Christian conciliation form with 2 witness signatures and addresses
Copy of your driver’s license and social security card
Copy of your spouse’s driver’s license and social security card (if
applicable)
Completed background and consent form with 5 years of residency listed
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CHI ALPHA CAMPUS MINISTRIES
1445 Boonville Ave
Springfield, MO 65802-0204
(417) 862-2781 Ext 1422
(417) 865-9947—Fax
CHIALPHA @AG.ORG
CAMPUS MISSIONARY-IN-TRAINING APPLICATION
Very important!
A $30 application processing fee must be sent in with the application.
Applications without the processing fee or photo will not be processed.
Please attach Instructions: Please type or print clearly. If sufficient room is not
recent photo. available to respond to any question, please state your response on a
separate sheet of paper. Completely type the question and your response.
Application will If you are married or engaged, your spouse or fiancé is to complete
not be accepted Section II and Assemblies of God US Missions Spouse Background
without photo. Investigation Consent form.
Please send us a copy of your social security card and driver’s
license, applications will not be accepted without both
documentations.
I. Personal Information
Date Available to Begin CMIT Date Completed
A. Full Name (first/middle/last)
B. Nickname/Preferred Name Sex Male Female
C. Present Address
D. City/State/Zip
E. Permanent Address (if different from present)
F. City/State/Zip
G. Phone: Home Cell
H. E-mail
I. Birth Date (month/day/year) Age
J. City, County, State of Birth
K. Country of Citizenship If you have a green card, what type?
L. Social Security Number
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M. Languages Spoken (primary and secondary)
N. Marital Status (at the time you may be interviewed) Single Engaged Married
Provide information if you have ever been Separated Divorced Widowed
O. Wedding Anniversary (month/day/year)
P. List your unmarried children, age 22 or younger, still living at home. List their full name, birth date,
social security number, and gender. If you are expecting, please note the due date.
Name Birth date SSN Gender
II. Spouse or Fiancé of CMIT Applicant (Section II only for spouse or fiancé)
A. Full Name (first/middle/last)
B. Nickname/Preferred Name
C. Birth Date (month/day/year) Age
D. Social Security Number
E. City, County, State of Birth
F. Country of Citizenship If you have a green card, what type?
G. Marital Status (at the time you may be interviewed) Single Engaged Married
Provide information if you have ever been Separated Divorced Widowed
H. Languages Spoken (primary and secondary)
I. College Attended, Degree, and Graduation Date
J. Present Occupation
K. Parents’ Name and Address
L. What are your feelings about and commitment to university ministry? Be specific.
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M. Is there any reason/concern, that you are aware of, that might make it unwise for you and/or your
spouse/fiancé to participate in next year’s CMIT program?
N. Please describe the level of maturity and stability in your marriage.
III. Family Background of CMIT Applicant
A. Name of Parents
B. Address
C. City/State/Zip
D. Occupation: Father Mother
E. Parent’s Church Membership Are they Christians? Yes No
If you do not want your parents contacted in the event of an emergency, check here.
F. Names and Ages of Brothers/Sisters
IV. Ministry/Ministerial Background
A. Do you currently hold ministerial credentials with the Assemblies of God? Yes No
What date and where did you receive your credentials?
Certified Minister Date District
Ministerial License Date District
Ordination Date District
If you don not have credentials, would you be willing to apply? Yes No
B. Which district presently holds your ministerial credentials?
C. What biblical and theological education have you had to date?
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D. What has been the nature of your involvement in secular campus ministry? Include ministry names and
locations and describe tasks and responsibilities specifically.
E. Outside of campus ministry, what other ministry/leadership responsibilities have you had? Provide tasks,
dates, places, and responsibilities.
F. Have you ever attended:
Student Activist Leadership Training (SALT)? Yes No
Student Institute of Campus Ministry (SICM) Yes No
Campus Ministers Conference (CMC) Yes No
Reach the University Institute (RUI – formerly ICM)? Yes No
Reach the University Institute-Church Track (formerly ICM-CS)? Yes No
G. Have you read the national five-fold Chi Alpha Mission Statement? Yes No
H. Do you fully subscribe to the national Chi Alpha Mission Statement? Yes No
V. Religious Background
A. Describe when (date) and where you were converted to Christ.
B. Have you received the baptism in the Holy Spirit? Yes No
When, where, and how did you know you had received the baptism in the Holy Spirit?
C. Have you been baptized in water? Yes No
VI. Education
A. High School
City/State Dates Attended
B. College/University(ies)
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City/State Dates Attended
Degrees/Diplomas
GPA from College/University
C. Why did you select the degree you chose for your undergraduate studies?
D. List special awards and/or areas of academic excellence.
VII. Personal Studies
A. Describe your normal devotional life. What is the normal content and format of these times?
What method of Bible study are you using?
B. What books and/or periodicals have you read during the past year that have impressed you?
Title/Author:
Title/Author:
Title/Author:
Title/Author:
Title/Author:
Title/Author:
Title/Author:
C. Please note any biblical books from the Old and New Testament that you have not read or feel you have
very little grasp of their basic contents.
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D. Please indicate your beliefs in regard to the following theological issues (provide scripture references):
Salvation
Healing
Speaking in Other Tongues (Acts 2:4)
Money and Material Blessings
The Second Coming of Christ
VIII. Occupational Background
A. Provide a history of places, dates, and types of employment you have held.
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B. Present Occupation/Employment and Dates
C. Have you ever been discharged or asked to resign from any employment or ministry position? Explain.
IX. Character/Relational
A. List any serious illnesses, emotional difficulties, learning disabilities, problems of substance abuse, or
special diets you, your spouse, or your children have now or have had in the past.
B. How many close, personal friends do you have presently? List by first names.
How do you share the Lord together?
C. Briefly describe how you respond emotionally to stress, time pressures, and expectation others may place
on you.
D. How do you express anger?
E. Have you ever been convicted of a crime? If yes, please describe.
F. Is your sexual orientation heterosexual, homosexual, or bisexual?
G. Describe your primary strengths of character. Answer fully.
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H. Please complete the chart below by rating yourself in each category. Use the following key:
1 – Almost never true (less than 15% of the time) 3 – Repeatedly true (more than 50% of the time)
2 – Irregularly true (less than 50% of the time) 4 – Almost always true (more than 85% of the time)
QUALITIES 1 2 3 4
Calling and Commitment to Missions
I am motivated to be a campus missionary
I have a long-term commitment to campus missions
Spiritual
I have a consistent devotional life
I am a person of godly morals
I operate in the spiritual gifts
I evidence spiritual fruit
Personal Character
I am a person of integrity
I am a person of self-discipline
I am a person who can be trusted
I am a person who lives under authority
People eagerly follow my leadership
I am a person of self-initiative
I am innovative and creative
I take necessary risks
I am able to stand on my own
Marriage and Family (if married)
I am supportive and respectful of my spouse
I am a good, open communicator with my spouse
I work to resolve conflicts in a healthy manner
I balance family and work priorities well
Physical and Mental Health
I am a person of energy
I manage stress well
I show no signs of abusive behavior
Interpersonal Skills
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
I have a warm, non-critical sense of humor
X. Campus Ministry
A. Do you feel called to full-time campus ministry? Please explain.
B. Do Christian friends, who know you well, affirm this calling or question it? Please explain.
C. How do your parents view your intentions to become a CMIT? Please explain.
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D. Are you an active member of a local church in your community? Yes No
What church?
In what ways do you serve this church?
E. Are you willing to make a 9-month commitment to a CMIT program with possible additional preparatory
studies? Yes No
F. What do you hope to gain from your CMIT experience? Please be specific.
G. What are your plans immediately following the CMIT program?
H. What would you do next year if you were not accepted as a nationally approved CMIT?
I. How would you provide for your financial needs for your CMIT program?
J. Do you have a home church willing to help you financially? Yes No
K. Do you have debts? Yes No
If yes, list the total amount, what they are (i.e. school loan, credit card), and how will you handle them.
L. What do you think you need specifically to occur in your life before you are able to be a career campus
minister/missionary? Answer fully.
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M. Are you currently involved in evangelist outreach? What is the nature of this outreach and how
consistent are you?
N. How many non-Christians do you have as on-going friends? Provide their first names.
XI. Emergency Contact Names
A. Name
Address
City/State/Zip
Phone (Home) (Work)
Relationship
B. Name
Address
City/State/Zip
Phone (Home) (Work)
Relationship
XII. References for CMIT Applicants
Three Character Reference forms have been provided with this application. Please have your campus
missionary/minister (or home church pastor if you have no campus missionary/minister) fill out one. Select
another persona who knows you well who has a position of ministry leadership (could include student
discipling leader.) Lastly, have an employer fill out a reference form. They are to fill these out privately and send to
the national office under separate cover. Provide them with a stamped, addressed envelope.
A. Campus Missionary/Minister
Name
Address
City/State/Zip
Phone (Home)
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Position and/or Relationship
B. Other Ministry Leader
Name
Address
City/State/Zip
Phone (Home)
Position and/or Relationship
C. Employer
Name
Address
City/State/Zip
Phone (Home)
Position and/or Relationship
XIII. CMIT Policies: Be sure to read carefully!
A. Upon receiving approval as a national Campus Missionary-in-Training, the CMIT is required to pay a
$100.00 CMIT fee to the national Chi Alpha office. You will be notified how to pay this fee upon
approval.
B. A CMIT is approved nationally and accepted locally. Once you have received national approval through
this application process, the national office will contact the local CMIT programs of your choice to gain
your acceptance into their program. With this application you will find a list of the CMIT programs for
the next school year. Please prioritize these programs (1 being first choice) and the national office will
inquire in this order. Every local CMIT program maintains the prerogative to accept or not accept any
nationally approved CMIT.
C. A nationally approved CMIT should attend the Reach the U Institute (RUI) prior to their CMIT
program experience. RUI serves as an orientation and preparation for the CMIT program experience.
Every CMIT with a national CMIT financial account must attend RUI prior to their CMIT program
experience.
D. CMIT programs prioritized, see XIII, B above (list at least three, no more than six.)
1.
2.
3.
4.
5.
6.
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XIV. Personal Biographical Sketch
A. Please include with this application a typed, personal biographical sketch of 300-500 words outlining the
general nature of your personality type and background. Include the primary formative events of your
life.
XV. CMIT Agreement and Authorization
General Council of the Assemblies of God, US Missions
Chi Alpha Campus Ministries Department
CMIT Agreement and Authorization
In making this application, I recognize the national US Missions (AGUSM) of the General Council of the
Assemblies of God, to be the agency designated to appoint Campus Missionaries-in-Training (CMIT).
I agree to abide by the agency’s decisions, and if approved, to cooperate fully with US Missions in
carrying out its policies and programs. I will submit reports as required by US Missions and complete forms
with relevant information. I will support the AGUSM morally, spiritually, and financially in accordance with
policy. I will also recognize that AGUSM, which has the responsibility to grant CMIT approval, has the right
to withdraw that approval. Should I prove by temperament, disposition, attitude, doctrine, practice, or other
reason to be unsuited for Assemblies of God CMIT approval, and should US Missions decide that my
approval be terminated, I agree to abide by AGUSM’s decision.
I realize that as a CMIT, funds raised by me through monthly pledges and offerings are the property of
US Missions of the General Council of the Assemblies of God. As a CMIT, I am entitled to a monthly
personal allowance as established by the US Missions policy and as designated moneys from donors are
sufficient for such allowance. This allowance is evaluated by AGUSM on a regular basis and adjusted as
considered appropriate.
Any funds received into my account by the General Council or received by me during deputational work,
in excess of my personal allowance, will be available to me only as work (ministry) funds, not as personal
income. I will report the use of these work funds to AGUSM on a monthly ministry report.
Should my approval as a CMIT be canceled at my option or by US Missions, all funds remaining in my
missionary account are the property of US Missions to use at their discretion, exclusive of any personal
allowance to which I may be entitled. If there is a deficit in my account, I will reimburse AGUSM for that
amount as soon as possible.
Authorization
The information contained in this application is correct to the best of my knowledge. I authorize any
references or churches listed in this application to give you any information (including opinions) that they
may have regarding my character and fitness for missionary work. In consideration of the receipt and
evaluation of this application by Assemblies of God US Missions, I hereby release any individual, church,
charity, employer, reference, or any other person or organization, including record custodians, both
collectively and individually, from any and all liability for damages of whatever kind or nature which may at
any time result to me, my heirs, or family on account of compliance or any attempts to comply, with this
authorization. I waive any right that I may have to inspect any information provided about me by any person
or organization identified by me in this application.
Signature Date
Applicant
Signature Date
Spouse of Applicant
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ASSEMBLIES OF GOD US MISSIONS
BACKGROUND INVESTIGATION CONSENT
I, hereby authorize Assemblies of God US Missions
and/or its agents to make an independent investigation of my background, references, character, past employment,
education, credit history, criminal or police records, including those maintained by both public and private organizations
and all public records for the purpose of confirming the information contained on my Application and/or obtaining
other information which may be material to my qualifications for US Missions status now and, if applicable, during the
tenure of my ministry with Assemblies of God US Missions.
I release Assemblies of God US Missions and/or its agents and any person or entity which provides information
pursuant to this authorization from any and all liabilities, claims or lawsuits in regards to the information obtained from
any and all of the above referenced sources used.
The following is my true and complete legal name and all information is true and correct to the best of my knowledge:
Full Name (Printed)
Maiden Name or Other Names Used
Date of Birth Social Security Number Driver’s License Number State of License
Please list below all residences where you have lived in the past 5 years. If necessary, use an attached sheet to
complete this request.
Current Residence: Previous Residence:
Years of residence: Years of residence:
Previous Residence: Previous Residence:
Years of residence: Years of residence:
Signature Date
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ASSEMBLIES OF GOD US MISSIONS
SPOUSE BACKGROUND INVESTIGATION CONSENT
I, hereby authorize Assemblies of God US Missions
and/or its agents to make an independent investigation of my background, references, character, past employment,
education, credit history, criminal or police records, including those maintained by both public and private organizations
and all public records for the purpose of confirming the information contained on my Application and/or obtaining
other information which may be material to my qualifications for US Missions status now and, if applicable, during the
tenure of my ministry with Assemblies of God US Missions.
I release Assemblies of God US Missions and/or its agents and any person or entity which provides information
pursuant to this authorization from any and all liabilities, claims or lawsuits in regards to the information obtained from
any and all of the above referenced sources used.
The following is my true and complete legal name and all information is true and correct to the best of my knowledge:
Spouses Full Name (Printed)
Maiden Name or Other Names Used
Date of Birth Social Security Number Driver’s License Number State of License
Please list below all residences where you have lived in the past 5 years. If necessary, use an attached sheet to
complete this request.
Current Residence: Previous Residence:
Years of residence: Years of residence:
Previous Residence: Previous Residence:
Years of residence: Years of residence:
Spouses Signature Date
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ASSEMBLIES OF GOD US MISSIONS
CHRISTIAN CONCILIATION AND ARBITRATION
AGREEMENT
In consideration of the following terms and provisions, and other valuable consideration the receipt of which I
acknowledge, the undersigned parties hereby agree as follows:
They accept the Bible as the inspired word of God. They believe that God desires that they resolved their dispute with
one another within the Church and that they be reconciled in their relationships in accordance with the principles stated
in 1 Corinthians 6:1-8, Matthew 5:23-24, and Matthew 18: 15-20.
Accordingly, the undersigned parties hereby agree that, if any dispute or controversy arises between them and is not
resolved in private meetings between the parties pursuant to Matthew 5:23-24 and 18:15, then the dispute or controversy
will be settled by biblically based mediation and, if necessary, legally binding arbitration, in accordance with the Rules of
Procedure for Christian Conciliation (Rules) of the Institute for Christian Conciliation, a division of Peacemaker Ministries
(rules available at www.HisPeace.org). The undersigned parties agree that these methods shall be the sole remedy for
any dispute or controversy between them and, to the full extent permitted by applicable law, expressly waive their right
to file a lawsuit in any civil court against one another for such disputes, except to enforce arbitration decision, or to
enforce this dispute resolution agreement. Any mediated settlement agreement, or arbitrated decision hereunder shall be
final and binding, and fully enforceable according to its terms in any court of competent jurisdiction.
Signature Date
Spouse Signature Date
Witness:
Address
Witness:
Address:
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CAMPUS MISSIONARY-IN-TRAINING
CMIT
CHARACTER REFERENCE
APPLICANT: Please print your name:
Name of applicant
I willingly waive my right to see this recommendation.
Signature
RESPONDER: The above named applicant is applying for a Campus Missionary-in-Training
internship program with our national college ministry. Your frank evaluation of the person named
will be appreciated.
1. In what capacity and for how long have you known the applicant?
2. How would you rate the applicant in the following qualities using the following key to evaluate:
1 = No Observation 2 = Below Average 3 = Average 4 = Very Good 5 = Exceptional
1 2 3 4 5 Comments
Intellectual ability
Reasoning ability to evaluate data
and make sound judgments
Creative ability to respond to new
ideas
Willingness to accept criticism
Verbal communication skills
Written communication skills
Work habits, prompt, thorough
Personal maturity
Emotional stability
Leadership potential
Attitude towards hard work
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1 2 3 4 5 Comments
Ability to get along with others
Attitude towards authority
Moral integrity
Self-initiating/self-motivating
3. Please state below your estimation of the applicant’s capacity and motivation for vocational
ministry leadership. Comment on the applicant’s moral character, relational skills, work habits,
and personal values as they pertain to developing leadership qualities.
4. I recommend this applicant to this internship training experience.
I do not recommend this applicant to this internship training experience.
I recommend with this reservation:
Signature:
Print name:
Position/title:
Address:
Phone: Date:
Thank you for your help.
Please return to:
Chi Alpha Campus Ministries
1445 Boonville Avenue
Springfield, MO 65802
417.862.2781 ext. 1425
Fax 417.865.9947
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