Date
08-22-2017

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 SchoolWorkingOther

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 month (all locations, June-July)1 month (select locations, June/July)*2.5 weeks (June 15-July 1st General Assembly)
* 1 month options are reserved for graduating high school seniors and those who have academic conflicts.

Which YiM context are you interested in?
UrbanRuralEither

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?