* Student Gender Female Male
* Student Grade in School Select one Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade Graduated
* Student Mobile Carrier Select a mobile carrier Unknown No Texting 3 Rivers Tel. Coop., Inc. Alaska Communication Systems American Messaging Appalachian Wireless Arch Wireless AT&T Bell Mobility Canada Bellsouth Mobility Bluegrass Cellular Boost C Spire Wireless Carolina West Wireless CBeyond Cellcom Cellular Network Partnership Cellular One (Illinois) Cellular One of NE Arizona Cellular South Centennial Wireless Chariton Valley Cellular (Bellcore Assigned) Chat Mobility Cincinnati Bell Claro - Puerto Rico Comcast (Xfinity) Mobile Commnet Wireless Consumer Cellular (AT&T) Consumer Cellular (T-Mobile) Copper Valley Cellular Cricket Docomo Pacific (Guam Wireless) Eos Mobile Family Mobile Fido Flat Wireless (ClearTalk) Freedom Mobile GCI GCI Communication Corp. Globalstar USA, Inc. Gold Star Communications, LLC Google Fi H2O Wireless Illinois Valley Cellular Inland Cellular Iowa Wireless Services Jasper/Cricket Keystone Wireless Kitty Wireless Koodo Mobile Leaco Rural Telephone Cooperat Metro PCS Mid-Tex Cellular, Ltd. Mobile Nation MTN MTS Communications N-Telos Nex-Tech Wireless Nextel Non-wireless Phone NW Missouri Cellular O2 (UK) Optus Mobile Orange (UK) Page Plus Pine Telephone Pioneer Cellular Plateau Wireless PR Wireless (Open Mobile) Public Mobile Pure Talk Qwest Republic Wireless Republic Wireless/Bandwidth.com (Sybase) Rogers Safelink Sagebrush Cellular (Nemont) SaskTel Simple Mobile Smart Telecom Solo Southern Communications Services, Inc. Spectrum Mobile Sprint Straight Talk Suncom T-Mobile T-Mobile (UK) Telrite Wireless Telus Mobility Thumb Cellular Ting Total Wireless Tracfone UBET Wireless Unicel Union Wireless United Wireless Communications US Cellular Verizon Viaero Wireless Virgin Mobile Virgin Mobile (Canada) Virgin Mobile (UK) Vodacom Vodafone (UK) West Central Wireless Wind Mobile z-AT&T (alt) z-At&t (alt2) z-Sprint (alt)
References - Please list the names of three references who know your character well. They must be 18 years or older and NOT related to you. You must provide their full contact information.
Statement of Faith & Church Involvement - Please answer the following questions completely.
* When and how did you come to know Jesus?
* What has your journey with Jesus been like?
* Do you consider Grace to be your home church? Select one Yes No
* Are you a: Select one Regular Attender (3-4 times a month) Casual Attender (once a month) Occasional Attender (once every other month or less)
* Are you involved in Student Ministry at Grace (GSM)? Select one Yes No
* In regards to GSM, are you a Select one Regular Attender (3-4 times a month) Casual Attender (once a month) Occasional Attender (once every other month or less)
* List all leadership/volunteer experience you have had:
Additional Information - Please be assured that all answers are kept confidential. We are asking these questions in order to be in compliance with our liability insurance carrier and to do our due diligence in screening those who interact with our minor students. We are committed to ensuring a safe and secure environment for all ministries. Not all affirmative responses result in exclusion from volunteering, but "yes" responses indicate a need for us to talk further. Some yes responses eliminate applicants from assuming a position of influence with minors. Please note that Indiana is a mandatory reporting state, so we are required to report any abuse or neglect to DCS.
* Have you ever been arrested, convicted, or plead guilty to a crime other than a traffic violation. Select one Yes No
* Have you ever been accused of, charged with, alleged to have, or have you ever committed an act of neglect, abuse, molesting, or battery? Select one Yes No
* Have you had any kind of relationship with a minor that has brought you sexual gratification? Select one Yes No
* Have you intentionally looked at pornography? Select one Yes No
* Have you ever been accused or convicted of possession and/or sale of controlled substances? Select one Yes No
* Have you ever been accused or convicted of driving under the influence of alcohol or drugs? Select one Yes No
* Do you use alcohol, tobacco, or any type of vaping product? Select one Yes No
* Has there been any abuse in your family background with drugs or alcohol or that was emotional, physical or sexual in nature? Select one Yes No
* Is there any circumstance or pattern in your life which would make it inappropriate for you to serve with minors? Select one Yes No
* Have you ever been asked to step down from working with minors in any setting, paid or volunteer? Select one Yes No
If you answered YES to ANY of the above questions, please explain your answer below:
Grace Kids & Student Ministries Applicants ONLY: - Grace Kids & Student Ministries Applicants ONLY:
Have you read our Child Protection Handbook? Select one Yes No
Statement of Agreeance: - Please type your initials below each of the following statements to acknowledge you agree with the statements provided.