Christian Youth in Action Application
Thank you for your interest in CYIA 2017! Please fill out the application below.
PERSONAL INFORMATION
First Name
Your answer
Last Name
Your answer
Gender
Home Phone number
Your answer
Cell Number
Your answer
Physical Address/Box number
Your answer
City
Your answer
Postal Code
Your answer
Email
Your answer
Birthday
MM
/
DD
/
YYYY
Current Age
Your answer
Marital Status
Manitoba Health Number
Your answer
Social Insurance Number
Your answer
Drivers License Number
Your answer
Drivers License Level
Do you have/own a vehicle that you are willing to use for summer ministry travel?
Your answer
Shirt Size
These are unisex.
How should your name be printed on your certificate?
ex. John Smith, Smith John
Your answer
In what languages are you fluent?
Your answer
Do you have health issues we should be aware of?
If yes, please tell us about them.
Your answer
Do you take medication?
*If yes - please list medications below.
Your answer
Do you have any physical limitations?
*If yes - please list limitations below.
Your answer
Do you have any allergies?
*If yes - please list allergies below.
Your answer
Emergency Contact Name
Your answer
Emergency Contact Relationship
Emergency Contact Home Phone
Your answer
Emergency Contact Cell Phone
Your answer
EDUCATION AND EXPERIENCE
Highest Level of Education Completed
Indicate year graduated.
Your answer
Special Training or Experience
ex. First Aid training, Leadership Training, etc.
Your answer
Work Experience
Indicate emloyer(s) and approximate dates.
Your answer
Experience with children
ex. Babysitting, kids club, etc.
Your answer
Which church do you currently attend?
Indicate years attended.
Your answer
Church Phone Number
Your answer
Church Address
Your answer
List previous churches you attended
Indicate years attended.
Your answer
What roles have you held in your church/community?
ex. Sunday School Teacher, VBS, camp, etc.
Your answer
Write a brief testimony of how you came to salvation.
Please also include what the Lord has been teaching you since you gave your life to Him.
Your answer
Have you previously been involved with CEF?
Indicate in what aspects.
Your answer
If involved as CYIA, list summers taught.
Your answer
How did you hear about the opportunity to become a summer missionary (CYIA)?
If friend or promotion, please list who or where.
Required
Why do you want to be a summer missionary with CEF?
Your answer
REFERENCES
Please provide the names, full addresses and phone numbers of three Christian adults outside your family who know you well. Include your pastor or youth leader as one of these.
First Reference (Name, Contact info, Relationship)
Your answer
Second Reference (Name, Contact info, Relationship)
Your answer
Third Reference (Name, Contact info, Relationship)
Your answer
COMMITMENTS
Check which weeks you are available to serve this summer.
Required training will take place on June 17 and July 4-14.
Required
Comments
Your answer
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