Summer 2025 CYIA Interest Form

Complete this form and click submit; this is the first step in the CYIA application process. Once we receive this form, a ministry coordinator will contact you for an interview.

Student's Information
If the student does not have their own phone number or email address, please use the parent's.

Name

Nickname/Preferred Name

This address will receive a confirmation email

Phone

What is the best way to contact you?

Please select one option.

Text Email Phone

Address

Birthdate

Gender

Please select one option.

Male Female

Please enter the grade you are currently in or just completed.

Grade

Please select one option.

4th 5th 6th 7th 8th 9th 10th 11th 12th Graduated High School College

School You Attend

Church

Pastor's Name

Parent/Guardian Information

Parent/Guardian Name

Parent/Guardian Email

Parent/Guardian Phone

CYIA Questionnaire

Affiliation

Please select one option.

CYIA

Have you accepted Jesus as your personal Savior?

Please select one option.

Yes No

Please tell us why you are interested in participating in the CYIA program.

I authorize Child Evangelism Fellowship of Greater Chattanooga to interview my child for the CYIA Summer Missionary program.

Please select one option.

Yes No I am 18 or older.

By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this form.

Applicant signature (type your name)

Parent/Guardian signature (parent types their name) REQUIRED for all applicants under 18; if 18 or older, type NA

Description

Complete this form and click submit; this is the first step in the CYIA application process. Once we receive this form, a ministry coordinator will contact you for an interview.

Summer 2025 CYIA Interest Form

Description

Please Fix the Following