URLThis field is for validation purposes and should be left unchanged.Program SelectionWhich cohort or location are you applying for?(Required) Online - January 22, 2026 Personal InformationName(Required) First Last What is your gender?(Required) Male Female Prefer Not to Say Date of Birth(Required) MM slash DD slash YYYY Email(Required) Mobile Phone(Required)Home Mailing Address(Required)(Include Apt #) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name of Church, Ministry or Organization(Required)Location of Church, Ministry or Organization City State / Province / Region ZIP / Postal Code Ministry Role or Position(Required)Leadership & MotivationWhat motivated you to apply for this program?(Required)How did you hear about UYWI and the program you are applying for?(Required) Referred (friend, staff, facilitator, trainer) Online (instagram, FB, Youtube, email etc) Website Event (Workshop/ Training) Other FinancialIf you are accepted into this program, how will you pay? The total program cost is $1,200(Required) Pay-in-Full Payment Plan Consent & PoliciesMedia Release(Required)I grant UYWI permission to use my likeness, voice, and video/image content in publications, social media, and promotional materials. I agreeAttendance & Payment Policy Acknowledgment:(Required) I understand that my enrollment will only be finalized after I complete payment or a payment plan.Attendance & Payment(Required) I understand that missed sessions or delinquent payments may impact my standing in the program.(Required)Commitment & AvailabilityThis program requires a consistent monthly time commitment and participation in scheduled in-person training sessions. Please review the program expectations before confirming your availability.Are you able to commit to the full duration of the program, including all scheduled sessions and requirements?(Required) Yes No Application SubmissionFinal Confirmation:(Required) I have reviewed my responses and confirm that all information provided is accurate and complete.Signature (Type Full Name)(Required) Δ
