Upper New York Volunteer in Mission Scholarship Application (revised 7/1/14)
This application is for prospective team members who need financial assistance in order to afford team participation, and who will contribute skills and spiritual gifts needed by the team. Scholarships are: for domestic teams, the greater of $100 or 20% of the cost of the mission; for international teams, the greater of $200 or 20% of the cost of the mission. Teams must have a trained team leader and provide health and accident insurance (see http://umvimnej.org/ ). Preference will continue to be given to youth or first time Volunteers-in-Mission; preference will be a maximum of 2 scholarships/team. Team leaders may also, on application, be granted 20% of their mission cost.
Every attempt will be made to respond within three weeks. Applications must be received at least 6 weeks prior to trip. Signed forms may follow online submission.
After completing the information and BEFORE clicking Submit, print the form so that signatures can be obtained. Send the signed form to: Roger Cullen, 9 Fox Holw, Ionia, NY 14475-9704.

*Required items must be filled before submitting form.

Applicant Information
Name *
Name of scholarship applicant
Your answer
Phone no. *
Your answer
Address *
Street, City, Zip
Your answer
Your answer
Please add my email address to the Conference VIM email updates list.
(approx. 2 messages/month)
Local Church *
Your answer
Select the Upper New York District of your church (if known)
Project Information
This is needed to determine exactly which mission team trip you wish to join.
Destination *
Your answer
Trip dates *
Start - End
Your answer
Project type
Check all that apply
Anticipated total trip cost/person *
Your answer
UNYVIM Scholarship Amount Requested *
The amount of this request
Your answer
Team and Leader Information
Please ask your team leader for info you don't know. The leader's signature is required on the form so info should be accurate.
Leader's Name *
Your answer
Leader's phone
Your answer
Leader's email
Your answer
Is this team open to volunteers beyond your local church? *
Has this team trip been registered with the Conference VIM Coordinator? *
If Conference TEAM funding support has been applied for, it already has.
What year was this leader's last UMVIM Team Leader Training?
Your answer
How will this applicant increase the diversity of the team or provide needed skills and spiritual gifts? *
Be sure that this applicant and the team leader both understand these expectations.
Your answer
Check Payee Name and address of treasurer to whom check should be sent. *
Scholarships can be sent only to a church or VIM Project Treasurer
Your answer
Stop! Do not click Submit button until you print this completed form.
If you click Submit before printing, you will not be able to print the form and use it to obtain signatures. Print first, then click Submit when you have your paper copy.
Required Signatures


Church Mission Chair or Council Chair--

Team Leader--

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