Cooperative Metropolitan Ministries
IFYI 2012 APPLICATION FORM, JULY 8-16, 2012
NAME
ADDRESS
CITY STATE ZIP
TELEPHONE 
CELL
CELLE-MAIL
DATE OF BIRTH GENDER
GENDERANTICIPATED DATE OF HIGH SCHOOL GRADUATION (MONTH/YEAR) *IF APPLICABLE*
FOR COLLEGE STUDENTS, DATE OF COLLEGE GRADUATION
NAME OF PARENT(S) OR LEGAL GUARDIAN(S) *IF APPLICABLE*
FROM WHAT PART(S) OF THE WORLD DO YOU TRACE YOUR PREDOMINANT ETHNIC HERITAGE?
WHAT ARE SOME OF YOUR FAVORITE ACTIVITIES OR AREAS OF INTEREST? HAVE YOU BEEN INVOLVED IN LEADERSHIP, PEACE-BUILDING, OR SERVICE EXPERIENCES?
RELIGIOUS INVOLVEMENT
RELIGIOUS AFFILIATION
NAME OF RELIGIOUS COMMUNITY (IF APPLICABLE)
MAIL ADDRESS
NAME OF CONTACT PERSON, TITLE, PHONE NUMBER, EMAIL
HOW DOES THIS PERSON KNOW YOU?
REFLECTIONS
IN A FEW SUBSTANTIVE PARAGRAPHS, PLEASE TELL US ABOUT YOURSELF. PLEASE BE SURE TO ADDRESS ALL THE AREAS MENTIONED BELOW. THERE ARE NO RIGHT OR WRONG ANSWERS. WRITE IN THE MANNER THAT BEST HELPS YOU COMMUNICATE YOUR THOUGHTS.
1. WHAT SIGNIFICANT MOMENTS OR PEOPLE IN YOUR LIFE HAVE INFLUENCED WHO YOU ARE TODAY?
2. WHAT ARE SOME GOALS YOU HAVE FOR THE NEAR AND MORE DISTANT FUTURE?
3. WHAT ARE YOUR INTERESTS IN FAITH, PEACEMAKING, LEADERSHIP, ETC?
4. WHAT DO YOU HOPE TO GAIN FROM ATTENDING THE INTERFAITH YOUTH INITIATIVE?
HOW DID YOU HEAR ABOUT IFYI?
NAME OF CONTACT PERSON (IF APPLICABLE)
IF ACCEPTED, I AM REQUESTING (CHECK ALL THAT APPLY)
LETTER OR EMAIL OF RECOMMENDATION/NOMINATION
AT LEAST ONE LETTER OR EMAIL IS REQUIRED. CHOOSE SOMEONE WHO KNOWS YOU WELL AND WHO IS NOT A MEMBER OF YOUR FAMILY (FOR EXAMPLE: A TEACHER, MENTOR, RELIGIOUS LEADER, COACH). PLEASE WRITE THE NAME, ADDRESS, AND PHONE NUMBER OR EMAIL ADDRESS OF THE PERSON WHO WILL COMPLETE YOUR RECOMMENDATION. ASK THE PERSON TO EMAIL US AT IFYI@COOPMET.ORG OR WRITE US AT:
COOPERATIVE METROPOLITAN MINISTRIES
ATTN: INTERFAITH YOUTH INITIATIVE
474 CENTRE STREET
NEWTON, MA 02458
NAME
POSITION AND ORGANIZATION
PHONE NUMBER
ADDRESS
EMAIL ADDRESS
AGREEMENT
I CERTIFY THAT ALL THE ABOVE INFORMATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT I MUST FALL BETWEEN THE AGES OF 15-18 (YOUNG ADULT PROGRAM) OR FALL BETWEEN THE AGES OF 18-22 (COLLEGE-AGE TRACK) DURING THE SUMMER OF IFYI. IF ACCEPTED I AGREE TO PARTICIPATE IN THE FULL PROGAM AND ABIDE BY THE RULES AND REGULATIONS OF THE INTERFAITH YOUTH INITIATIVE.
ELECTRONIC SIGNATURE OF APPLICANT
DATE
THIS IS TO CERTIFY THAT I GIVE PERMISSION FOR MY DAUGHTER/SON TO ATTEND THE INTERFAITH YOUTH INITIATIVE (IF APPLICABLE)
ELECTRONIC SIGNATURE OF PARENT/GUARDIAN
DATE
© 2012 - Cooperative Metropolitan Ministries (CMM)
474 Centre Street - Newton, MA 02458
Office: (617) 244-3650
Alexander Levering Kern, Executive Director (akern@coopmet.org)
Matt Carriker, Program Director/IFYI (ifyi@coopmet.org)
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