Pink House Application

Please read our creed and the following information and confirm your commitment to participate:

The Pink House Internship is a ten-month experience that places interns in a community setting while exploring urban ministry and growing in leadership development. Participants volunteer 5 hours per week to their local agency, participate in a weekly house meeting to study core content curriculum on urban issues, and take intentional time to spend with housemates and in the community. Interns are exposed to various avenues of service including hospitality, and taken to various training events including a 5-day out of town conference, two weekend retreats, various workshops and community events. Students live in community together in the Pink House, and are able to hold a part-time job and/or be a student through the extent of the program.

Fees/Finances: The Internship Program has no overall cost; however, rent is to be paid at the beginning of each month in the amount of $175/person or $325/couple. Wireless internet is available at a small fee. Personal expenses are handled individually. Most training event fees are covered, small expenses might be incurred at an event (such as personal meals) from time to time.
 

Terms of Release
1. In consideration for being accepted and allowed to participate in this conference/project and activities associated with its program and location, I personally assume responsibility for my actions, and release InterVarsity Christian Fellowship/USA® (hereafter InterVarsity®), its Trustees, employees and agents from loss, injury or damage to myself or my property; provided that nothing contained herein shall excuse InterVarsity, its Trustees, employees or agents from responsibility to act with reasonable care for the safety of myself or my property.

2. I give permission to InterVarsity to be photographed, recorded, and/or video taped and to allow this material to be used for publicity.

3. I give permission to InterVarsity to obtain medical assistance in the event of an emergency. This permission will include the administration of medicines, surgical treatment, X-ray examination or hospitalization as might be ordered by a licensed medical doctor. I release and discharge InterVarsity, its trustees, employees, and agents from any liability for any first aid rendered or treatment performed pursuant to this consent.

4. I understand that InterVarsity has a hostage policy that states that InterVarsity should not yield to demands, including the payment of ransom or other extortion, issued through the use of hostage taking or extortion.

5. If I am under age 18 (if you are, please check here ), I state that I am a mature minor of college age and living away from parent/guardian and have the capacity to consent to the terms of the Release.

6. Any claim or dispute arising from or related to this release shall be settled by mediation and if necessary, legally binding arbitration in accordance with the Rules of Procedure for Christian Conciliation of the Institute for Christian Conciliation, a division of Peacemaker® Ministries (complete text of the Rules is available at www.HisPeace.org). Judgment upon an arbitration decision may be entered in any court otherwise having jurisdiction. I understand that these methods shall be the sole remedy for any controversy or claim arising out of this release and expressly waive my right to file a lawsuit in any civil court against InterVarsity for such disputes, except to enforce an arbitration decision.

7. Additionally, in applying for this internship, I pledge to fulfill the following:

a. To be willing to be part of this experience by retaining a flexible spirit and be open to new things. To work with staff and housemates in making the internship a success. To evaluate it afterward to help future interns have a better experience.

b. To put in at least 5 hours per week with the agency with which I've been placed from September 1 to June 10, and to work hard as unto the Lord.

c. To meet weekly at specified times with the other interns and to go through the agreed upon curriculum and any related assignments. To be prepared for these meetings.

d. To attend the 5 day out of town conference, the Fall and Winter Pink House retreats, mandated training events including: City Scope & Tour, and the designated amount of City Chats and Church visits.

e. To participate in our annual Pink House fundraiser.

f. I understand that I will be living in community at the Pink House. I will be flexible with regard to my placement and living arrangements.

g. I further certify that I have read and agree to the Pink House Creed, that I intend to fully participate in the activities and life of the Pink House, and that I will complete assignments and agreed upon roles. I desire to be considered for the ministry of the Pink House. I certify that my participation in this ministry and its various surrounding meetings will be voluntary. I understand that participation carries risks inherent both to such activities and the location of the house. I personally assume responsibility for my actions, and for myself and any who would claim under me, I release InterVarsity Christian Fellowship of the USA, its trustees, employees and agents, A Place for You Foundation (APFYF), and First Presbyterian Church from any liability for loss, injury, or damage to my person or property which may result from my participation, provided that nothing contained herein shall excuse IVCF, APFYF, or First Presbyterian, their trustees, employees, and agents from responsibility to act with reasonable care for the safety of myself or my property. Should any dispute or controversy arise, I agree to seek resolution according to Biblical principles through the Christian Conciliation Service.

PINK HOUSE APPLICATION
Name
Gender
Street Address
Apt Number
City
State

Zip
Home Phone
Cell Phone
Email Address
T-Shirt Size
Declared Major
Year in School

Emergency Contact Information
Name
Street Address
Apt Number
City

State
Zip
Phone

Parent or Guardian Information (if different from Emergency Contact Information)
Name
Street Address
Apt Number
City
State
Zip
Phone

Participant’s College or Health Insurance Policy Information
Company Name
Policyholder Name
Policy Number

Personal Reference (pastor, IVCF staff, employer who knows you well, not a family member)
Name
Phone
Email Address

Do you have any medical concerns we should be aware of (if yes, please explain)?

Are there any physical or emotional limitations that may require special consideration (if yes, please explain)?

Are you currently under the care of a physician? If so, please explain and provide the name and phone number of your physician.

List any prescription medications being taken.

Are you currently taking medication or under a doctor’s care for depression (if yes, please explain)?

Have you at any time in the last 3 years attempted suicide?

YES NO
Do you have any allergies or medical conditions we should be aware of to avoid problems and to assure proper emergency action?

Do you have any food restrictions that we should be aware of to avoid problems?

Can you move in by August 15th?

YES NO
If not why and when?
Are you willing to commit to 10 months there?

YES NO
Have you had roommates before?

YES NO
In what context?

Do you have your own transportation?

YES NO
What is the name of the Church do you attend?

Are you able to agree with the Pink House Creed and to sign it?

YES NO
Which aspects of the creed do you most resonate with and why?

How long have you been a Christian?
What experiences have most shaped your Christian life?

Why are you interested in being considered for the ministry of the Pink House?

What is your previous experience in ministry (urban or other)?

How have you handled inter-personal conflict in the past?

Which aspects of the requirements of the Pink House described in our brochure or otherwise, most excite you?

Which concern you and why?

 

Electronic Signature of Applicant

I certify that I have read the above paragraphs and am competent to submit this release, and have done so voluntarily.

Enter Full Name

Before submitting this application with deposit, please print (control + p on your keyboard) a copy for your records.