You must register for the Field Education Internship (PT535) at the beginning of
the semester. In addition to registration you must complete the form below to be
turned in to Rod Culbertson.
FIELD EDUCATION INTERNSHIP REGISTRATION
PERSONAL DATA
Student Name ____________________________________________________
Mailing Address
________________________________________________________________
Phone Number ____________________ E-mail __________________________
HOME CHURCH
Church where you hold membership
________________________________________________
How long have you been a member of this congregation?
_______________________________
Are you under care of the session of this church?
______________________________________
Mailing Address
________________________________________________________________
Pastor’s Name ___________________________ Phone ___________________
PRESBYTERY
Are you under care of a Presbytery? ______________
Date came under care _____________
Name of Presbytery _______________________________________________
CHURCH/MINISTRY SITE AND MENTOR FOR INTERNSHIP
Church/Ministry Site
_______________________________________________________________
Mailing Address
________________________________________________________________
Mentor’s Name ___________________________ Phone __________________
Why do you desire to have a pastoral internship at this church? _____________
________________________________________________________________
________________________________________________________________
Describe your future plans for professional ministry
________________________________________________________________
________________________________________________________________
________________________________________________________________