Project - Kairos Inside Excellence Initiative

Kairos Inside: Excellence Initiative Report - Pre Program

Part 1
To be completed and submitted prior to the start of the Program

The information provided in this form will be used to complete the final EI Report that you give at the end of the Program.
To enhance the quality and effectiveness of our ministry for the benefit of participants.

Do not take this form into the prison as it contains phone numbers and email addresses.

Note:
- The completed form must be submitted as soon as possible prior to the start of the Program.
- You will be provided with information to help complete this form by email from the Kairos Support Office as part of the Program Notification Form process.
- Use the tabs at the top of this form to navigate between pages.
- Please click here for instructions on how to use this online form if you need further information.
Step 1: Contact Information

To be completed by the State Council or nominee.
Regional Committee and Program Number

RegionNumber eg: #25
Kairos Short Course Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Kairos Short Course Institution
EI State Administrator Name

FirstLast
EI State Administrator Email
example@kairos.org.au
EI State Administrator Phone Number
Please enter a valid phone number.Format: 0000-000-000.
State Council
State Council Chair Name

First NameLast Name
State Council Chair Email
example@kairos.org.au
State Council Chair Phone Number
Please enter a valid phone number.Format: 0000-000-000.
Regional Committee
Regional Committee Chair Name

First NameLast Name
Regional Committee Chair Email
example@kairos.org.au
Regional Committee Chair Phone
Please enter a valid phone number.Format: 0000-000-000.

Step 3: Kairos Short Course Information

Complete this section as soon as all information is available
Leader Name

First NameLast Name
Leader Email
example@kairos.org.au
Leader Phone Number
Please enter a valid phone number.Format: 0000-000-000.
Leader Personal Email
example@example.com (if required)
Advising Leader Name

First NameLast Name
Advising Leader Email
example@kairos.org.au
Advising Leader Phone Number
Please enter a valid phone number.Format: 0000-000-000.
Observing Leader Name

First NameLast Name
Observing Leader Email
example@example.com
Observing Leader Phone Number
Please enter a valid phone number.Format: 0000-000-000.
Excellence Initiative Representative

First NameLast Name
Excellence Initiative Rep Email
example@example.com
Excellence Initiative Rep Phone Number
Please enter a valid phone number.Format: 0000-000-000.
Additional Information from the KSO:
This is the end of part 1. Part 2 of the Excellence Initiative Form will be sent to you prior to the start date of the Program. Please click on the Submit button below to send this form to your EI State Administrator.
Should be Empty:

Kairos Inside: Excellence Initiative Report - Pre Program

To be completed and submitted prior to the start of the Program

Step 1: Contact Information

Step 2: Review - State Council and Regional Committee endorsements.

Step 3: Kairos Short Course Information

This is the end of part 1. Part 2 of the Excellence Initiative Form will be sent to you prior to the start date of the Program. Please click on the Submit button below to send this form to your EI State Administrator.