Summer Medical Institute - 2008
Student Application
 
 

  Contact Information
  Full Name:
    Gender:
  Local Address:
  City:
  State:
  Zip Code:
  Phone: ex. 123-456-7890
  Date leaving this address:
  Date of Birth  
  Email:

  Parent(s) Full Name:
  Parent(s) Address:
  Parent(s) Phone:  
  Home Church:  
  Address:
  Pastor:  
  Current Church:  
  Address:
  Pastor:  
  School Information  
  School:
  Program:
  Expected Grad Date:  

  Additional Comments (if any):

  Questions
  Are you proficient in Spanish?  
  Have you discussed SMI with your parent(s)? If so, what was their response?
 
  How did you hear about the SMI as an opportunity for your summer?
 
 

List the names of the two people who will be writing your personal and professional recommendation.

List their phone or email, and their relationship to you.
 
 

Briefly describe any relevant training opportunities you have had that my relate to your SMI participation

(i.e. health care related jobs, cross-cultural exposure, ministry experiences, etc.)
 

 

Briefly describe this history of your journey with God:
 

  Past participants have described the SMI as "the hardest summer you'll ever love." Whether it's the heat, community living, recognition of sin, or being burdened by others' needs, you undoubtedly will be challenged this summer. The SMI provides intensive training in the context of real life experience. In light of this:
 

Are you willing to submit to God's process of developing you in character and discipline?  

 

Are you willing to learn how to communicate about Jesus Christ and the Gospel?  

 

Are you willing to be involved in intensive study and application of the Bible?  

 

Are you willing to participate fully in all scheduled project activities?  

 

What is your life vision or calling as you know it to be at this point?
 
  How do you envision your future career? Please be as specific as you can at the present time.
 
  Explain why you want to participate in the SMI this year.
 
  Due to the nature of this project, any absence from the SMI must first be pre-approved by the project directors. Please make your request here for any dates between June 27th and July 26th that you may need to be away from the SMI (to participate in a wedding, school orientation, or family requested function)
 

 

For Your Information

  1. All applications are subject to approval of the Summer Medical Institute Board of Directors.

  2. Please have your letters of recommendation sent directly to the Valley Baptist Family Practice Residency, 2222 Benwood St, Harlingen, TX 78552 or email to familypractice@valleybaptist.net SMI office by March 15.

  3. Please Click here to download the Personal Rec. Form
    Please Click here to download the Professional Rec. Form

    The personal rec. should be someone who knows you well and can comment on the benefits of your participation in the SMI. This could be a Bible study leaders, pastor, close friend, SMI alum, etc. The professional rec. should be someone who is familiar with your calling and abilities in the health professions. This could be a dean, professor, pre-med advisor, mentor in your field, family friend, etc.

  4. Acceptance letters will be sent out no later than April 1.

  5. Applying does not commit you to the SMI. If accepted, you must then return a confirmation form by April 15 to reserve your place.

IMPORTANT, PLEASE READ THE FOLLOWING BEFORE SUBMITTING THIS FORM:

What a person believes is the foundation for both life and ministry. The following are Christian tenets to which the SMI leadership ascribes. If you disagree with any of these, please explain your differences below.

  1. The Bible is the inspired, infallible, inerrant Word of God. (2 Tim. 3:15-17)

  2. There is one God, eternally existent in three persons: Father, Son and Holy Spirit. (John 10:30)

  3. These are central truths of the Christian faith: The deity of our Lord Jesus Christ, His virgin birth, His sinless life, His miracles, His vicarious and atoning death through His shed blood, His bodily resurrection, His ascension to the right hand of the Father, and His personal return in power and glory. (Jn 1:1-5; Phil. 2:5-11, 1 Cor 15:1-6)

  4. Believing in the person and work of Jesus Christ alone results in salvation; Jesus Christ is the only way of salvation. (Titus 3:4-7; Eph. 2:8-9; John 14:6; Acts 4:12)

  5. The Holy Spirit's present ministry and indwelling enables the Christian to live a godly life. (Gal. 5:16-23; I John 1:3-4)

The commitment of the Summer Medical Institute is "to serve and not to be served." Serving in ministry means you sometimes submit to the needs of others even in areas of biblical freedom. Paul is a model of this (Romans 14 - 15:6). Serving with the SMI means you agree to the following:

  1. I am willing to set aside personal preferences, habits and schedules to fulfill the ministry of the SMI.

  2. I understand there are variations in practice and understanding of Scripture in some areas of Christian living. In serving with SMI, I will abide by the standards of the SMI in all areas including dress, entertainment, activities, etc. This includes a willing agreement to abstain from the use of alcohol, drugs, and tobacco and being sensitive to cultural, regional, church and SMI expectations and standards. See the enclosed "Policies and Procedures" page for a description of SMI expectations and standards.

  3. I will seek to provide excellent medical care to God's glory and to present Jesus Christ as Lord and Savior.

  4. If accepted to the SMI, I am willing to raise support for my participation, trusting God for His provision with a target goal of $2,200.00. I acknowledge that God is sovereign and He shall supply all of our needs according to His glorious riches in Christ Jesus

Please state your agreement with the above, or state any differences in opinion in the box below:

 


I have read the SMI application and accept its provisions and agree to live, work and serve in accordance with them. I, the undersigned, also realize that in accepting a term of volunteer service, it is with the clear understanding that SMI does not assume responsibility for loss of my property, damage to the same, personal harm or illness that may come to those who travel with me or myself. I, for myself, my heirs, executors, administrators and assigns, in consideration of my admission to volunteer service and other good and valuable considerations, do hereby release and forever discharge SMI, the Valley Baptist Health System, the Valley Baptist Family Practice Residency from liability for any claim or demand that I or my heirs, executors, administrators or assigns might otherwise assert upon the basis of any of the foregoing. In volunteering, I recognize that I do not become an agent or employee of SMI in rendering my services and I agree to hold SMI harmless from any claim that might arise out of any acts performed by me while serving as an SMI volunteer.
   

Please enter the last four digits of your social security number and click on submit, if you are in agreement with all of the above, or have disclosed your disagreements in the space provided above.

 
 

                

 
If you have any questions, feel free to call 956-389-2448, fax 956-389-2498, or email familypractice@valleybaptist.net.
If you had any problems submitting this form, please download the word documents and fax or mail your information to the address or number above.

Please click here to download the form
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