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2019 Cohort A-pilot program4219575219075APPLICATION─────────────────For in-cohort use only, please add your photo to this application by selecting this photo. (double click on it) In the toolbar “replace image” will appear as an option, click that and follow the instructions. Name: ___________________________________________________________________Your position and name of your church: ________________________________________ Vineyard church ID number _____________ Regional Leader’s name ________________Affinity group applying for: □ Bi-vocational □ La Vi?a □ Planter □ Sage □ WomenCell phone _________________________ Email address _______________________Address ______________________________________________________□ I am available to attend the inaugural retreat in Chaska, Minnesota, April 25-28, 2019.Demographic QuestionsGender: □ Male □ FemaleAge Range: □ 20-30 □ 31-40 □ 41-50 □ 51-60 □ 61-70 □ 71+Race: □ Asian/Pacific Islander □Black □ Caucasian □Hispanic □Mixed □Prefer not to specifySize of your congregation: □under 50 □51-100 □101-200 □201-400 □401-1000 □1001+Position of service:□ I am a stand-alone senior pastor□ I am a co-senior pastor□ I am a female senior-level leader looking toward pastoringHighest Education Level Completed:□ High School diploma □ Some college □ 2-year degree program □ 4-year BA/BS degree □ M.A./M.S./M.Div degree □ post-graduate degree Additionally, check if any of your academic experience was □ theological or □ divinity related.Previous Experience with a Mentor, Coach, or Spiritual Director: Check all that apply. In the column on the right please share about your experience. You could include names of your mentors, how long you worked with him or her, whether they were in in the Vineyard, and what you thought of the value of that particular experience.□ Mentor (imparts experience, skills and information)□ Coach (assists you in dreaming, goal-setting, and accomplishing your vision)□ Spiritual Director (accompanies and co-discerns the presence and activity of God)___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________General QuestionsWhen/where did you start in the Vineyard? ________________________________________________How long have you served in your current position? ________________________________________Who are the five people closest to you? ______________________________________________________________________________________________________________________________________Here’s how I describe my personality: (If helpful, you may use language from Meyers-Briggs, DISC, Enneagram, etc., if known). ___________________________________________________________The way I learn best is: _______________________________________________________________ ___________________________________________________________________________________On a Likert scale of 1-5, please place an x in the box that describes your response to the following statements. (Write or type “N/A” in column “3. No Opinion” if the question does not apply to your situation).1. Highlydisagree2. Somewhat disagree3.Noopinion4. Somewhat agree5. Extremely agreeI have interest in trans-local leadershipMy church is in a healthy placeI am looking for new opportunities & job locationsI like to give backMy friends comment positively on my vulnerability in conversationsI enjoy being bi-vocationalI have a life-calling to full-time ministryMy schedule has some extra time availableOthers comment that I could use some work in the area of follow throughI am committed to pastoring my neighborhood and cityI could see myself leading other pastors I am good at self-assessmentHealth is a high priority to me.I always read & follow the instruction manual.1. Highlydisagree2.Somewhat disagree3.Noopinion4. Somewhat agree5. Extremely agreeI want to finish well as a pastor.I always accomplish my goals.I want to cooperate with the Spirit’s formative work in my life.I like learning things that can help me and others.I care about the well-being of other pastors and leaders.I want to pursue health and wholeness.Others comment on my punctuality.On a scale of 1-10 please enter a number in the left column to rate your self-assessed abilities over the past 5 years in the following areas:Was a joyful learnerCommitted follow-throughVolunteered for leadership beyond the local churchServed others with a good attitudePursued physical healthPursued mental/emotional healthPursued spiritual healthOffered my insights to othersHad at least 3 closer friends who are Vineyard pastorsGrew in community with othersWas open & vulnerable with othersBuilt relationship with other Vineyard pastors in my AreaListened well to othersInteracted at least monthly with other pastors locallyGrew personallyGrew spirituallyWas good at self-assessmentBuilt relationship with other Vineyard pastors in my regionHeard God and obeyedTook a weekly sabbath rest Short AnswerFor this short answer section, if you have a printed version and need more room, please clearly mark your extra paper with the question number and add it to your documents when you scan it as a single upload. If entering electronically, just type until you are finished.1. After discussing the time commitment of this intensive pilot program with your spouse, what are some of the words used to describe his/her feelings about your participation? ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________2. Discuss how you will make time in your life for the extra hours this Well-being of Pastors Initiative requires of its cohort participants. ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________3. Why do you want to participate? _________________________________________________________________________________________ _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________Affirmations□ I affirm I have the motivation and emotional space to participate in this 2-year Well-being of Pastors Initiative.□ I affirm that I am eager to benefit from a relationship with a Mentor, Coach, and Spiritual Director.□ I affirm that I am willing to journey with a cohort of fellow Vineyard Pastors in open, honest relationship so that we may become healthier, stronger, and wiser.□ I affirm again that I am able to participate in the inaugural retreat on April 25-28, 2019.□ I affirm that my church participates in 3% giving to Vineyard USA. (Non-senior pastors, please verify with your pastor.)□ I understand that my Regional Leader will be contacted to affirm my participation in this Well-being of Pastors Initiative.Signature of applicant _____________________________________________________Signature of applicant’s spouse _____________________________________________ Date of completed application ______________________________________________Office USE:Date received _____________________________Recommendation __________________________Interview/Follow-up questions/notes: ................
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