Spuntik Impact application form 2017 18 .pdf
Original filename: Spuntik Impact application form 2017-18.pdf
Author: Cat Bowman
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Bedford Base 2017 - 2018
Please complete application form in ink and in capital letters.
Address (inc postcode):
Skype (if available):
Date of Birth:
Age by September 2017:
If married, when did you get married (date):
If engaged, when are you getting married (date):
Do you have a full driver’s licence:
Will you have the use of a car during the Impact
year? (We need to know for organizing host
accommodation for you during your training blocks)
Are you taking medication under a doctor’s direction?
If YES, please give details of condition:
Are you generally in good health?
Do you need a special diet?
If YES, please give details:
Page 1 of 6
Home Church Name:
Home Church Address (inc postcode):
Name of Church Leader:
Church Tel No:
Church email address:
We will contact
your church leader
Have you discussed your
application with church eldership?
Have you been baptised in water?
Have you been baptised in the
asking for any
comments that he
or she feels may
be appropriate to
How long have you been a member of this church?
In what ways have you been involved in the life of your church?
Page 2 of 6
What do you believe your strengths to be?
What are your weaknesses?
What are your goals in life?
Why have you applied to do Sputnik Internship/Impact?
What is your occupation? (If you are a student, please indicate this here, then move on to
‘Education’ on page 5)
How long has this been your occupation?:
Nature of responsibilities and duties:
If unemployed, please give last occupation with dates:
Page 3 of 6
Please give details of your educational qualifications:
What creative disciplines do you practice in and what is your focus?
Write about your creative story up to this point- no more than 300 words (how did you get into
your art form? Who are your main inspirations? What are the things you’ve done you’ve been
most proud of, etc. Please feel free to use another sheet of paper.)
Please include with this application 3 pieces of work that are representative of what you do, and
please can you write about your favourite of these 3, including how it came about and why you
value it- no more than 300 words (Please feel free to use another piece of paper).
It is fine simply to provide links to work that is clearly exhibited online. However, if your work is not online, please could
the pieces of work be attached digitally (don’t send physical copies). Preferred formats:
If they are large files, use www.wetransfer.com and send them to firstname.lastname@example.org with the message ‘Sputnik
Page 4 of 6
How do you propose to finance yourself?
The UK fees will be
£1350.00 (with a
£150 discount if based
at home in Bedford)
Please note, Impact does
not assist with travel
expenses, but Sputnik
will provide work
expenses including travel
round Birmingham during
Many churches help towards the cost of training—have you
discussed this with your church leadership?
There may be an optional
artist residential during
the year, which may incur
an extra cost. This will be
between £100 and £200.
PLEASE SIGN BELOW for your application to go forward.
By signing below you are agreeing to the following:
I will send a non-returnable deposit of £50.00 to the Impact Administrator if offered a place
on Impact (payable to “Woodside Church”).
If my church is contributing to my fees, I agree to undertake the responsibility of ensuring
the correct amount of money is paid to the Impact Administrator as per agreed
If financing myself, I agree to send full payment to the Impact Administrator as per agreed
deadlines (payment in instalments can be arranged).
Page 5 of 6
Please write down your testimony in not more than 500 words, and include details of your
conversion, water baptism & baptism in the Holy Spirit (continue on a separate sheet of paper if
In order for your application to be considered, please have your church leader print, sign
and date here:
I endorse this application
Church Leader’s Name:
Signature of Applicant:
Page 6 of 6
Please can you return this application form to:
Ruth Matthews, Impact Administrator - Bedford,
Woodside Church, Dover Crescent,
Bedford, MK41 8QH
Tel: 01234 272022
At the same time, please can you also email
email@example.com to simply tell me that
you’re applying to the Sputnik Internship.
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