Todays Date*

First Name*

Last Name*

Preferred Name

Current/School Address*

Current/School City*

Current/School State*

---AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyomingOther

Current/School Zip Code*

Email*

Confirm Email*

Is email a reliable way to contact you?

---YesNo

We will primarily use email to correspond with you. Plase make sure we are on your safe senders list. All our correspondence will come from the following e-mail address: fuller@dfocus.org

Current Phone*

Permanent Address

Permanent City

Permanent State

---AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyomingOther

Permanent Zip Code

Other Phone

Other Email

Home City

Home State

---AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyomingOther

Age*

Birthdate*

Gender*

---MaleFemale

Date Graduated from High School

Name of College or University

Class Next School Year

---FreshmanSophomoreJuniorSeniorGraduate SchoolNot in School (Graduated)Not in School (Have Not Graduated)

Major

Current Place of Employment (If Applicable)

What type of career/job would you like to have once you finish your education?

Shirt Size

---Adult SAdult MAdult LAdult XLAdult XXLAdult XXXL

What are your hobbies and interests?

Preferred Location

---TennesseeMissouriEither

Why This Location? (check those that apply)

Relational connection to Discipleship Focus staff or previous alumni from that location.Location is beneficial financially and for transportation purposes.Location is closer to where I am taking kids to YL Camp.Other

If Other, explain:

1. Please tell us in detail about the following things. Write at least three or four sentences for each section.

a. How has your year been both spiritually and otherwise?

b. List any areas in which you are currently struggling.

c. Why do you want to return?

d. What are your goals and expectations for the summer?

2. Young Life Involvement (check all that apply):

WyldLife participantYL high school participantYL college participantWyldLife LeaderYL Leader (for high school)YL Leader (for college/university)YL Capernaum LeaderYoungLives LeaderWork Crew, Summer StaffYL Camp Summer InternYL Student Staff, None

3. Do you think you might bring a car?

---YesNo

4. Do you play any musical instruments or sing in public?

If yes, if there is a need, would you be willing to help lead worship for the summer?

---YesNo

5. Have non-prescription drugs, illegal use of prescription drugs, tobacco, vaping, or excessive use of alcohol in the past three months?* If so, please explain:

If yes, are you confident you can refrain from using these substances during the program?

---YesNo

6. Who was your previous small group leader?

Keeping in mind that ultimately your small group leader will be prayerfully decided by leadership, would you be excited to have the same small group leader or would you be open to a different small group leader?

7. Do you have any Young Life camp trips or other commitments you must keep during the program period? Family vacations or other entertainment related trips will not be approved.

8. Room Cleanliness (We can't guarantee anything!)

---Like Neat RoomLike Messy RoomDon't Care

I agree to keep the following commitments:

---YesNo

a) I will stay for the entire length of the program, unless I prearrange a short leave for school or Young Life reasons. If I have to miss any of the program, I will keep up with the required study.

b) I will attend and be on time to all required meetings, and other functions.

c) I will submit to the program leadership and those in authority at work.

d) I will read the chapter(s) assigned each week, write out answers to the questions, and come prepared to small group discussion meetings.

e) I will spend regular one-on-one time with the leadership.

f) I will work willingly, cheerfully, and to the best of my ability at whatever job I am assigned. I will be at work each scheduled day, unless legitimately sick, be on time, and submit to the authority and regulations of leads and supervisors.

g) I will make every effort to develop closeness and unity with my cabinmates, be open and available to friendships with the entire community, include others in activities and avoid "cliques".

h) I will refrain from the use of tobacco, nicotine, alcohol, and non-prescription or illegal drugs the entire time I am living at either Discipleship Focus property--before, during, or after the program.

i) I will be “non-exclusive” and “non-physical” in relationships, both within and outside the program.

j) I will avoid bringing or using a personal laptop or desktop computer in my cabin during the summer, AND will refrain from bringing my cell phone to required meetings.

k) I will be in my own cabin and in my own bunk by the designated curfew times.

Signed* (note, this qualifies as a digital signature):

Please leave this field empty.