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Mission 2022
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Youth Summit Application

When you’re ready to apply, simply fill out the application below and we’ll get back to you shortly!

Note: All fields are required unless you don’t meet a stated conditional (such as being over 18 and not needing parental approval). If you have any trouble filling out this form, please email magabook@youthsummit.info

About You

Apply as:

Program Cycle:

In which conference would you like to participate? *

Full Legal Name *

First

Last

Email *

Cell Phone *

Parent Phone

Date of Birth *

Current Age *

Gender *

Male
Female

Do you have a Social Security Number? *

Yes
No

Do you have a Student Visa?

Yes
No

Home Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

School Information

School Name *

Phone *

School Address *

Address Line 1

City

State

Zip Code

Current Field of Study *

Where will you attend school next year? *

Have you been baptized? *

Yes
No

Have you ever canvassed before?

Yes
No

Have you ever been a canvassing leader before?

Yes
No

Which conference or school did you lead for? What year was it?

Why did you sign up for magabook canvassing?

Why did you sign up for a leadership position?

List any leadership roles you held in the past. (School, Pathfinder, etc.)

What value are most important to you as a leader?

How can you contribute to a leadership team?

What do you do for self-motivation?

How much driving experience do you have with a minivan?

What kind of canvassing leader would you like to be known as?

Earliest date that you will be available *

Your Favorite Hobbies *

Your Favorite Music Groups *

Reference

Note: You cannot put a parent’s information in reference.

Name *

First

Last

Email *

Phone *

Health Insurance

If you do not have health insurance, it will be provided to you for a nominal fee

Are you covered under a health insurance plan? *

Yes
No

Checkboxes *

I have read and understand that insurance will be purchased for me.

IMPORTANT: Since you are not covered under a health insurance plan, insurance will be purchased on your behalf for a nominal fee.

Allergies and Medications

Are you taking any medications? *

Yes
No

Are you allergic to any medication? *

Yes
No

Do you have any food allergies *

Yes
No

Name *

First

Last

Email *

Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Disclaimer

All students are subject to a background check under the Federal Fair Credit Report Act. Failure to consent to the consumer report, including the criminal record check, will result in ineligibility to participate in our program. You will be asked to sign a consent form authorizing this.

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