CYIA Application | CHRISTIAN YOUTH IN ACTION OF MICHIGAN

CYIA 2024 Student Application

Application is due by May 15, 2024. Please send a $50 application fee as soon as possible after submitting this online application. Total cost of CYIA is $500. If paying with paypal, please add $15 to cover the 3% paypal fee. Go to cefmi.com/giving Click on "donations". Balance is due no later than June 16, 2024 when you sign in at CYIA. An additional $25 for the CYIA Field Trip on Saturday, June 22 can be paid at CYIA registration on June 16.

Notice of Non-discrimination Policy

Child Evangelism Fellowship® admits students of any race, color, ethnic origin, and nationality to al privileges, programs, and activities available through our training programs.

My local CEF chapter/worker

Name (First, Last - as you want it on your certificate))

Gender

Female

Male

Name you want on your name tag

Date of Birth

Phone

Address

City, State, Zip

Whose email did you give?

My parent's email

My email

Name of Parent/Guardian

Address of Parent/Guardian if different then you gave above.

Phone Number of Parent/guardian

Email of Parent/guardian (if different from above)

Student T-Shirt Size (Adult Sizes)

Small

Medium

Large

X-Large

CYIA Experience

First year at CYIA

2nd year at CYIA

3rd year at CYIA

4th or more year at CYIA

Please check CEF Ministry and training that you have participated in

5-Day Clubs

Good News Clubs

Fair Ministry

Teaching Children Effectively® 1

Teaching Children Effectively® 2

Personal Testimony

Please provide information regarding when and where you trust Christ as your Savior. Include at least one Bible verse that helps you know that you are truly saved. If you are a returning student, please share how the Lord has been working in your life over the past year.

Personal Testimony

Please write a brief summary of why you would like to attend Christian Youth In Action and how you plan to use the training you recieve.

Personal References

Please provide name and contact information for 1. Your pastor/youth pastor/spiritual leader and 2. a non-related adult friend. You can download paper reference forms for them to use or direct them to this link to fill out the reference form online. REFERENCES ARE DUE BY MAY 30, 2024

Reference #1 (First and last Name, Phone, Email)

Reference #2 (First and last Name, Phone, Email)

Acknowledgement Statement

I understand that completion of CYIA training does not guarantee that I will be accepted for service this summer. I also understand that my attitude toward CYIA staff and fellow students does matter. I understand that while I am at Grace Christian University for CYIA, I am under the authority of the Director of CYIA and all the staff. I understand that I am to follow the rules and guidelines that are outlined in the CYIA Student Guide.

Student Signature

Photo Release

I give absolute right and permission to use my pbotgraph(s), likenesses or images in a publication, electronic media (e.g. video, internet, CD, or other forms of promotional materials for CEF®, their offices, employees, agents, designees, and the photographer from liability for any violation of any personal or proprietary right I may have in connection with such use. I hereby state I have read carefully and understand the foregoing and know the contents thereof, and I state my agreement with these legally binding agreements as my own free act.

Agree to Photo Release

Yes, I agree to the Photo Release statement above

No, please do not use any photos of this student in any promotional material.

No, I do not want any pictures of this student taken.

Student Signature

Date

Parent/Guardian (A parent or guardian must also sign with and for a minor - under age 18)

Date

Medical History for CYIA Students

Providing the following information will help the CYIA Leadership Team be more effective in working with your student. This information will remain confidential.

Name of Student

Emergency Contact 1 (First and Last Name, Phone, Relationship)

Emergency Contact 2 (First and Last Name, Phone, Relationship)

Date of last Tetanus shot

Mark all that apply

Anemic

Autism

Depression

Diabetes

Dyslexia

High blood pressure

High blood sugar

Low blood pressure

Low blood sugar

Panic Attacks

Seizures

Please list any allergies and intolerances (nature, food, medicine)

Please list all medications you take - prescription and non-prescription

Medical Permission

Parent/Guardian: Please give insurance information for the student and provide your signature for a minor (student under age 18)

Student Name (First and Last)

Student date of birth

Name and phone number of family doctor

Insurance Company Name

Policy Number

Relationship of insured to student

Name of Insured Person

Phone number of insurance contact (if available)

Signature of Parent/Guardian

Date

Signature of Adult student

Date

Finishing up

Once you submit this application, contact your references to give them the paper reference form or the link to the online form to fill out. Your local CEF worker will contact you to do the following: 1. Complete the CEF Child Protection Policy (if you are a new student or have turned 18 since CYIA 2023); 2. Read the CEF Statement of Faith and Workers' Compliance Agreement; 3. Conduct an interview with you. Once we have recieved your application, references, registration fee, and your Child Protection Policy status, you will receive an acceptance letter to CYIA via email. Your local CEF worker will also make sure you receive the CYIA memory verse list, Bible Lesson text, missionary story text, and student guide to help you better prepare for CYIA.