Impact Application Form

Impact Team Application Form

Please fill out the form carefully and completely! Don't leave any items blank- enter "none" if there is no information for that item!
Student Name *

First Name Middle Initial Last Name
Birth Date

Month Day Year
Age *
Grade *
If School hasn't started yet, what grade are you going into?
Gender *
Address *

Street Address

Street Address Line 2

City State

Zip Code
Student E-mail *
example@example.com
Student Mobile Number

Area Code Phone Number
Home Phone Number *

Area Code Phone Number
Home Church *
Best way to contact student *
Tell us some about you:
I want to join the Impact Team and: *

learn/better my skills as a singer learn/better my skills musician learn/better skills as part of the Audio Team learn/better skills as part of the Video Team learn/better my skills in working with children learn/better my skills in sharing Jesus learn or better my skills in serving others learn/better my kitchen skills
Hobbies that I have: *
Musical Instruments I play: *
Other talents I have: *
Share with us!
What other activities on the AZ Nazarene District are you part of? *
Camp,. Camp Meeting, Quizzing, NYC, NYI Leadership, etc
What other activities are you involved in at your local church? *
Worship team, youth group, leadership, child care, etc
Why do you want to be part of the AZNYI District Impact Team? *
Tell us why you want to join the Impact Team!
T-Shirt Size (Adult sizes) *
Answer the following questions to tell us about your relationship with Christ.

Take this portion of the application seriously! This is probably the most important part!
Explain how your relationship with Christ began *
Take this part seriously! Honesty and realness is important to us!
Explain how and why your relationship with Christ has grown *
Take this part seriously! Honesty and realness is important to us!
Tell us how God is using you to make a difference in the world around you *
Take this part seriously! Honesty and realness is important to us!
Tell us how you think God can use you to further accomplish His will *
Take this part seriously! Honesty and realness is important to us!
Recommendation info

Be sure this info is correct- we will use this to seek recommendations for you! If you need to leave part of the recommendations blank (ie: no pastor at the moment, just write "none" and "none@none.com and 111-111-1111.
Father's name *
Father's Phone number *

Area Code Phone Number
Father's E-mail *
example@example.com- These will be used to gather recommendations, so be sure these are correct!
Mother's name *
Mother's Phone number *

Area Code Phone Number
Mother's E-mail *
example@example.com- These will be used to gather recommendations, so be sure these are correct!
Pastor's Name *
Pastor's Phone number *

Area Code Phone Number
Pastor's E-mail *
example@example.com- These will be used to gather recommendations, so be sure these are correct!
Youth Leader's name *
Youth Leader's Phone number *

Area Code Phone Number
Youth Leader's E-mail *
example@example.com- These will be used to gather recommendations, so be sure these are correct!
EMERGENCY INFO- *
List ALL allergies, Food sensitivities, and other medical conditions. This includes pets you may be allergic to!
Emergency Contact's name *
Emergency contact's Phone number *

Area Code Phone Number
Emergency Contact's Relationship to student *
Emergency contact's E-mail *
example@example.com
Anything else you want us to know? *
if none- tell me a joke
How did you first hear about the Impact Team? Select all that apply *

Impact came to my church! I heard about Impact at Camp! I won a t-shirt at Camp or someone threw candy at me at Camp! Google search for "Awesome things to do as a teenager in Arizona" Friend/Family/Church Member told me- tell us their name in "Other"
I have read the "What is Impact" page and looked over the schedule. *
Yes or no
Digital Signature *
Type your full name here to acknowledge that you have read the entire Application page and that this form is filled out truthfully. Signing here also means that you understand that if information is left blank or inaccurate, that it may affect your application process.
Thank you for Applying!

Applications will be looked over, recommendations will be requested, and we will let you know shortly if you have been approved to join the next season of the AZNYI District Impact Team!
Please: Make Checks to AZNYI

Send in your $25 Application fee as soon as you can! This fee will go towards your $110 yearly Fees of the Team, or will be refunded if Applicant is denied. mail to: Impact Team c/o Eddie Laub 5606 E. 28th St. Tucson, AZ 85711
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Impact Team Application Form

Tell us some about you:

Answer the following questions to tell us about your relationship with Christ.

Recommendation info

Thank you for Applying!

Please: Make Checks to AZNYI