CityWhich cohort are you applying for?(Required) New York City - In-Person, Winter '24 Student InformationName(Required) First Last Email(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 Mobile Phone(Required)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.)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. FinancialIf 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 ByHow 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 PhoneApplication SubmissionI have reviewed all of my answers in this application and all of the information I've provided is complete and accurate.(Required) Yes Additional Comments (optional) NameThis field is for validation purposes and should be left unchanged. Δ
