CYIA™ Application

Child Evangelism Fellowship of Mississippi Inc.
Training Dates: June 6 - 12, 2021
Flint Creek Waterpark,
1216 Parkway Dr, Wiggins, MS 39577 
Christian Youth in Action® (12 years old to College Age)
For more information contact: Beth Johnson - or (601) 498-3641

Save & Return

Save your progress and complete this form later. (optional)

Take special care to save your sign in and password as it is not recoverable.

Personal Information

Choose T-Shirt size *
I understand that I am expected to attend a CYIA pre-training with my local CEF® chapter prior to CYIA. The date for this pre-training will be communicated by my Local Director/Coordinator. (Please initial below)

Other Personal Information

CEF of Mississippi's Child Protection Policy MUST be completed online by going to Click on the volunteer tab and then select "NEW Volunteer" and complete all questions with an answer. It will be helpful for you to have three references with all their information ahead of time before you go online so you do not time out while completing the form. Once completed select submit. You will be called for a brief interview to be conducted and your local director/coordinator will check your ID (driver's license or school photo ID)


List your church first, then your pastor or other church leader, followed by others who know you well and will not mind being contacted by CEF (not a relative or previous employer)
Pastor Reference
Church Leader Reference
Reference 3
Reference 4

Education/Training and Experience

List schools you are currently attending along with any Biblical or evangelism training you have had in the past.
 Name and LocationDegree or Certificate TypeCompletion Date


I am willing to work with Christian young people as a team teaching 5-Day Clubs and will cooperate with my supervisor, the other trainees, the CYIA staff, and local director. I am willing to follow the rules and dress code of CYIA and understand that failure to do so will mean that I must leave CYIA training at my parents' expense.
I agree to teach/assist at least two weeks of 5-Day Clubs after CYIA training is completed or the equivalent as determined by my local CEF director.
Please choose the dates you are available to teach 5-Day Clubs. Also, please write the best times of day you are available below the calendars so we can schedule clubs accordingly for you to fulfill your post-training club teacing commitment.
 Available (Yes or No)
June 15 - 19
June 22 - 26
July 6 - 10
July 13 - 17
July 20 - 24
July 27 - 31
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