PERSONAL LEADERSHIP APPLICATION PhoneThis field is for validation purposes and should be left unchanged.Program SelectionWhich cohort are you applying for?(Required) Online - Virtual, September '26 Applicant InformationName(Required) First Last What is your gender?(Required) Male Female 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 State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country 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 InformationHow many years have you been involved in ministry?(Required)(Please provide whole number and not a range.)Which of the following describes your ministry vocational status?(Required) I work full-time in ministry (i.e., receive full-time pay from the church, ministry or organization) I am bi-vocational (i.e, I work elsewhere but also receive some pay or stipend from the church, ministry or organization) I am strictly a volunteer (receive no pay) How many youth do you serve?(Required) (Please provide whole number and not a range.)Referred ByHow 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 agree Attendance & Payment Policy Acknowledgment(Required) I understand that my enrollment will only be finalized after I complete payment or a payment plan.Acknowledgment(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
