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Youth Reaching Youth Registration Form
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Please enable JavaScript in your browser to complete this form.
Name
*
First
Middle
Last
Gender
Male
Female
Address
*
Birth Month
*
--- Select Month ---
January
February
March
April
May
June
July
August
September
October
November
December
Birth Day
*
--- Select Day ---
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Birth Year
*
--- Select Year ---
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
Mobile Number
*
Email
*
TRN Number
*
NIS Number
*
Name of Church
Denomination
Church Address
Church's Phone Number
Number of years you have been a Christian
Check the box that indicates education level you have completed
*
Primary / Preparatory School
Secondary / High School
is medical? How
Please list below: the Schools attended, the year attended and the graduation year.
*
Please list subject/s achieved and grade, if any - (CXC, CAPE, City & Guilds, etc)
Who do you live with? (Please write Parent / Guardian names)
*
Parent / Guardian Cell Number
*
Who has been supporting you financially?
*
How does this person / family feel about your plan to join YRY?
*
What is your biggest concern about joining this programme?
*
In what youth leadership position or activities have you participated in or is currently participating in? Please indicate that position.
*
Describe volunteer activities, interests and hobbies.
*
Have you ever been in trouble with the law?
*
Yes
No
If Yes, Please explain.
Have you ever been suspended / expelled from School, fired from your job or put under Church discipline? If yes, why?
*
Do you have any children or is one on the way?
*
Yes
No
How would you describe your health / medical?
How would you describe your ability to relate to your peers? (Do you have friends?)
How would you describe your ability to relate to authority?
Which area in the field of Youth Development would you like to see changed 5 years from now, and how do you propose to help achieve this?
*
What do you hope to gain by being a part of the Youth Reaching Youth Mission?
*
Can you commit to the programme for one year? (Must be available from 8 a.m. – 4 p.m. Mon – Fri and be willing to minister on weekends).
*
Yes
No
If No, Please state reason
Please state your vocational goal(s).
How did you heard about the programme:?
*
--- Select Choice ---
Television
Newspaper
Radio
Church
School
Other
If other, Please state how.
Referral Code (Please enter current Youth Leader full name):
Have you done City & Guild subjects?
*
Yes
No
If "YES", list subjects & stage(s) you have achieved
If you wish to pursue a higher stage, then SELECT TWO City & Guilds subjects (Mathematics & English) you want to pursue (Stages 1, 2 and 3)
ENGLISH (Stage 1)
ENGLISH (Stage 2)
ENGLISH (Stage 3)
MATHEMATICS (Stage 1)
MATHEMATICS (Stage 2)
MATHEMATICS (Stage 3)
Choose an Associate of Arts Degree course: Conditions apply.
*
--- Select Choice ---
Criminal Justice (LAW)
Entrepreneurship
Tourism
Date
*
E-Signature
*
Submit
