2018 Mission Circle & Real McCoy Application
This form is to be completed by any student that personally raised $100 or more for SFC in 2017. Applicant must be between the ages of 12-25 years old (never married). Form should be submitted by September 04, 2017.
Email address *
Applicant Personal Information -
Please submit a picture of yourself.
Last Name: *
First Name: *
Home Address: *
City: *
State: *
Zip Code: *
Home Phone: *
Cell Phone: *
Gender: *
Date of Birth: (month/day/year) *
Current Age: *
Father's Name:
Mother's Name:
Name of Guardian: (if applicable)
Emergency Contact Information -
Emergency Contact - Name: *
Emergency Contact - Home Address: *
Emergency Contact - City: *
Emergency Contact - State: *
Emergency Contact - Zip Code: *
Emergency Contact - Home Phone: *
Emergency Contact - Cell Phone: *
Emergency Contact - Relation to Person: *
If you qualify and plan to attend Real McCoy Weekend (Nov. 3-4), will you be traveling with a chaperone? {A sponsor (age 21 or older) may accompany winners under the age of 16. If a sponsor accompanies a minor, there is a limit of one sponsor/chaperone/family member per minor. A minor may travel unaccompanied with parent, pastor, and youth president approval. This sponsor will be responsible for his/her own expenses.} *
Chaperone Name: (if applicable)
Christian Service History -
Name of the Church you currently attend: *
Pastor's Name: *
How long have you attended this church? *
Pastor's Home Address: *
Pastor's City of Residence: *
Pastor's State of Residence: *
Pastor's Zip Code of Residence: *
Pastor's Phone Number: *
Have you received the Holy Ghost with the initial evidence of speaking in other tongues? *
Have you bee baptized in Jesus' name? *
Contest Criteria -
In which church related activities have you been involved? (Check all that apply) *
List your district involvement (i.e. sectional youth rallies, youth convention, camp, etc.) *
How much money did you personally raise for SFC this year? *
Explain how you raised your offering and include details on how you used creativity and hard effort to reach your goal. *
Is your Parent / Guardian aware of you submitting this application? *
Is your Pastor aware of you submitting this application? *
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of Illiniyouth.org. - Terms of Service - Additional Terms