Christian Youth in Action - 2024 Application
CYIA Student
Name
*
First Name
Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gender
*
Please Select
Male
Female
CYIA Student
Birthdate
-
Month
-
Day
Year
CYIA Studen
School /Work Information
*
Information
High School Nme
Current Grade Level
College Name
College Grade Level, Degree
Employment Status
Primary Phone Number
*
Phone Number Type
*
Please Select
Cell
Home
Work
T-Shirt Size
Please Select
Small
Medium
Large
X Large
2X Large
3X Large
CYIA Student
Parent/Guardian #1
- Contact Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone
*
Parent/Guardian #1
Primary Phone Number Type
*
Please Select
Cell
Home
Work
Secondary Phone
Parent/Guardian #1
Secondary Phone Number Type
Please Select
Cell
Home
Work
Parent/Guardian #1
E mail
*
Parent/Guardian #1 (example@example.com)
Parent/Guardian #2
- Contact Information
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone
Please enter a valid phone number.
Primary Phone Number Type
Please Select
Cell
Home
Work
Parent/Guardian #2
Secondary Phone
Parent/Guardian #2
Secondary Phone Number Type
Please Select
Cell
Home
Work
Parent/Guardian #2
E mail
Parent/Guardian #2 (example@example.com)
Back
Next
Christian Youth in Action - 2024 Application
Page 2
Emergency Contact Information - Alternate Pickup/Release
Emergency Contact #1
Name
*
First Name
Last Name
Primary Phone Number
*
Please enter a valid phone number.
Primary Phone Number Type
Please Select
Cell
Home
Work
Parent/Guardian #1
E mail
Parent/Guardian #1 (example@example.com)
Relationship to Child
Emergency Contact #2
Name
*
First Name
Last Name
Primary Phone Number
*
Please enter a valid phone number.
Primary Phone Number Type
Please Select
Cell
Home
Work
Parent/Guardian #2
E mail
Parent/Guardian #2 (example@example.com)
Relationship to Child
Back
Next
Christian Youth in Action - 2024 Application
Page 3
References
Pastor Reference
*
Reference Information.
Full Name
Church
Phone Number
Email
Address
CEF Worker / Mature Adult
*
Reference Information.
Full Name
Church
Phone Number
Email
Address
Mature Adult
*
Reference Information.
Full Name
Church
Phone Number
Email
Address
Back
Next
Christian Youth in Action - 2024 Application
Page 4
Spiritual Life
With what denomination and/or local church are you connected?
*
How have you been involved in your local church?
*
Are you willing to be involved in a ministry which may mean working with denominations other than your own, but which are in agreement with the Child Evangelism Fellowship's Statement of Faith? Are you in full agreement with the Child Evangelism Fellowship?
*
Yes
No
Write a biological sketch describing your Christian experience. You must include:1) The basis of your salvation 2) Your spiritual growth since conversion 3) Your practices in prayer, Bible study, church attendance, fellowship and witnessing 4) Your Christian service 5) Your convictions regarding tobacco, drugs, and alcohol 6) Your purpose for applying to the CYIA program
*
Have you ever been arrested or convicted of child abuse
*
Yes
No
If you answered Yes to the child abuse question, provide information
*
Have you served with Child Evangelism Fellowship in the past? Describe involvement and provide contact information of your supervisor.
Describe any training and experience you've had with Child Evangelism Fellowship
Have you been used to lead a child to Christ?
I understand that I am expected to attend a CYIA™ per-training with my local CEF Chapter prior to CYIA. The date for this pre-training will be on May 18th from 9:00 am – 3:30 pm. I agree to teach/assist at least two weeks of 5-Day Clubs after CYIA training is completed or the equivalent as determined by my local CEF Director. Trainee / Parent Guardian
*
Back
Next
Christian Youth in Action - 2024 Application
Page 4
Name of Parent/Guardian
Signature of Parent/Guardian
I agree to teach/assist at least two weeks of 5-Day Clubs after CYIA training is completed or the equivalent as Parent/Guardian: determined by my local CEF Director. DEPOSIT FEE of $50.00 must accompany this application and is non-refundable. The remaining $350.00 for training will be due by May 29, 2024.
Yes
No
Application Deposit - $50.00 non-refundable
prev
next
( X )
CYIA Application Deposit
CYIA application deposit (non-refundable)
$
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Continue
Continue
Should be Empty: