Prefer to mail in a copy? You can download the application and mail it to:

BUMP, 172 15th street, Buffalo NY 14213

Download it HERE.

Name *
Name
Address *
Address
Phone *
Phone
http://
If private, please let us know so we can "friend" you.
http://
Birthday *
Birthday
Gender *
What is your ethnicity?
Do you speak any other languages?
Where do you currently attend?
Education Level *
Please indicate your highest level of education
Major and Minor(s) please
Please list 3 references and include name, phone #, e-mail address, and relationship to you. Please include an employer/supervisor, a pastor or member from your church community, and one other reference
Work Placement Questions:
What is your desire for your service placement? *
Check all that apply
Personal and Faith Questions
Other
Answering ‘yes’ to the following questions will not disqualify you from the program
Do you have any current or ongoing medical issues? *
Do you have a history of mental health issues? *
If yes, please explain below
Do you have a history of drug or alcohol abuse? *
If yes, please explain
Have you ever been convicted of a crime? *
If yes, please explain below
Do you have current debt that you are responsible for paying during the BUMP program? *
Are you free from commitments that could interfere with your BUMP year? *
BUMP Rules
BUMP interns must commit to the following: A deepening recognition of and response to God’s work in, around and through you In areas of weakness and failure, receive input, guidance, correction, accountability from mentors, supervisors and other BUMP members. Offer input, guidance, correction, accountability to other BUMP members Nurture relationships with BUMP members by serving and encouraging them, as well as pursuing reconciliation in areas of conflict The highest effort and energy at the place of service Diligent and regular interaction with course material Failure to demonstrate cooperation in these areas may result in disciplinary action and/or disqualification from participating in BUMP. I understand the rules above, and the possible consequences of my failure to adhere to them:
Type Name To Agree with the BUMP Rules *
Type Name To Agree with the BUMP Rules
Typed name will be considered binding