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CERTIFICATION APPLICATION

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This field is for validation purposes and should be left unchanged.

City

Which cohort are you applying for?(Required)

New York - In-Person, Winter '26

Houston - In-Person, Winter '26

SEDUTH Online - Virtual, Winter '26

Online - Virtual, Winter '26

Kenya Online - Virtual, Winter '26

Student Information

Name(Required)

First Last

What is your gender?(Required)

Male

Female

Date of Birth(Required)

MM slash DD slash YYYY

Email(Required)

Home Mailing Address(Required)

(Include Apt #)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Church, Ministry or Organization(Required)

Location of Church, Ministry or Organization

City State / Province / Region ZIP / Postal Code

Mobile Phone(Required)

Ministry Role or Position(Required)

Leadership Information

How 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.)

Why do you want to enroll in UYWI's Certification Program?(Required)

Which of the following statements do you think best tell how your current ministry, professional, and personal responsibilities will support your involvement in the certification process?(Required)

I will be fully supported by ministry/profession/family.

I will be somewhat supported by ministry/profession/family and it will be a little challenging.

I will not at all be supported by ministry/profession/family but I'm determined.

I will not be supported at all by ministry/profession/family and I'm trying to figure out how I can do this.

Financial

If you are accepted into this program, how will you pay? The total program cost is $1,645 if paid in full or $1,735 if paid by payment plan.(Required)

Pay-in-full

Payment Plan

Referred By

How did you hear about the Certification Program?(Required)

Former Certification Program participant

Ministry Leader or Mentor

UYWI Website

Email

Social Media

Other

If you were referred by a former certification participant or organization, please tell us the name of the person or organization, otherwise skip to the next section.

Will anyone else from your organization/ministry be applying for the program, which would qualify you and the other(s) for a group discount if payment is being handled by one person?(Required)

Yes

No

If yes, what are the name(s) of the other members of your organization/ministry that will be applying?

What is the name, phone number, and email address of the person who will be responsible for the payment?

First Last

Email

Phone