Date
09/19/2018

First Name

Last Name

Age

Cell

E-mail

How did you hear about YIM?

Why are you interested in YiM?

Check all that apply to you:
High SchoolGraduating High School SeniorHigh School GraduateCollege (Private, State, or Community)University (Private, State or City)College/University GraduateTech SchoolWorkingMarriedAdult 18-25Adult 25-40Adult 40+

What social media do you use the most?

Describe your current relationship with Jesus...

Have you ever been on a Mission Trip?
YesNo

Which YiM Deployment Option are you most interested in?
2 month1 month2 weeks1 weekWeekendMission CampShort-Term Team

Which YiM context are you interested in?
UrbanRuralEither

Which Hub of Compassion are you most interested in finding out more?
Cactus, TXChicago, ILFlint, MIIndianapolis, INMartin County, KYMelbourne, FLOklahoma City, OKPhiladelphia, PASan Antonio, TXSeattle, WASW Native American District, AZSt. Louis, MOToledo, OHWinnipeg, MB

List 3-5 one word descriptions of what comes to mind when you read the word mission...

Thank you for completing this Interest Form. Once Submitted you will receive an email with a link to our YiM Application.
Got it!

Would you be willing to recommend 1-3 friends to be contacted by Youth In Mission to begin their Interest Form?

Name/Contact Info:

1.
2.
3.

Questions or Comments?