Weekend Leader Nomination Form

KAIROS PRISON MINISTRY INTERNATIONAL INC.
Weekend Leader Nomination Form for

Kairos InsideKairos OutsideKairos Torch
To be completed by the Advisory Council and the Nominee
Institution Advisory Council name
Advisory Council
Nominee Full Name:
Nominee leader name
Nominee Phone:
Nominee phone number
Nominee E-mail:
example@example.com
Nominee Address:
Nominee physical address
City/Town:
State:
Zip:
Nominee Denomination:
Nominee Worships At:
Interviewed by the Advisory Council on:

MonthDayYear
Date
Interview comments:
Has the nominee met the leadership track requirements for their Kairos Program?

YesNo
Number of Kairos Weekends nominee has served?
Led a prior Kairos Weekend

YesNo
Is the nominee involved in the Kairos continuing ministry of their program, if applicable?

YesNoN/A
Kairos Weekend jobs held in order to meet leadership track requirements (N/A for Kairos Torch):
Kairos talks given (minimum 2 for Kairos Inside and Kairos Outside):
Nominee’s attendance record at past team formation meetings. (i.e. attends 75% of meetings)
Will serve as Observing Leader (or OL#1) on Weekend
Kairos Inside or Torch program only requires one Observing Leadership term.
Location and date of Advanced Kairos Training attending:
OL Weekend Date:

MonthDayYear
Date
Will serve as Kairos Outside OL#2 on Weekend. (N/A for Kairos Inside or Torch program)
Outside OL#2 Weekend Date:

MonthDayYear
Date
If approved, will serve as Leader of Weekend # for their perspective program
Date nominee will serve as Weekend Leader.

MonthDayYear
Date
I have been briefed on the requirements for being a Weekend Leader, including Advanced Kairos Training (AKT), the use of EZRA and will follow the Program Manual.
Signature of Nominee for Weekend Leader.
Nominee signature date

MonthDayYear
Date
Advisory Council Chair Signature:
AC Chair signature date

MonthDayYear
Date
To be completed by the State Committee.
Approved by State Committee

YesNo
State Chair Signature:
Date

MonthDayYear
Date
Should be Empty: