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Summer Communities of Service Application

 Part I Application


Summer Communities of Service

May 30 - August 11, 2012

Questions?


Apply here for 2012 Summer Communities of Service

Please contact Rev. Mary Schaller Blaufuss, Executive for Volunteer Ministries
700 Prospect Ave. E., Cleveland, OH 44115-1100
Phone:  (216) 736-3214 or toll-free (866) 822-8224 ext. 3214
Fax:  (216) 736-2294  *  Email:  blaufusm@ucc.org
Summer Communities of Service do not discriminate against applicants on the basis of religion, race, color, national origin, sex, age, sexual orientation, or disabilities.

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This introductory application allows staff to get to know the experiences and skills you offer for a volunteer placement.  Completion of this form begins the application process but does not commit you to participation nor guarantee placement.  Staff will electronically send you the second part of the application and forms for written references.
   
 
   
Title   
Last Name
First Name 
Address 
City
State
Zip Code
Country
Phone
Cell Phone
Fax
E-mail Address
Date of Birth (mm/dd/year)
   
EMERGENCY CONTACT (Person who can always reach you.)
Name 
Address
City 
State 
Zip Code 
Phone 
Cell Phone 
Fax 
E-mail Address 
   
Are you available for these dates for Summer Communities of Service:
Dates of Service, including Orientation and De-briefing May 30 - August 11, 2012
 Yes           No

Yes           No

 
Types of Skills and Experience YOU bring (Check all that apply) 
Languages Spoken or Written
Your Experience
Your Experience
Your Experience
 
Your Experience
 
Your Experience
Your Experience 
Your Experience
Your Experience 
Your Experience 
Case Management Your Experience 
Your Experience 
Your Experience 
Class & Certifications: 
   
Possible Service Settings
(Indicate interest by 1, 2, 3, 4, 5 with 1 as little interest and 5 as great interest.)
Immigration & Border Ministries 
Construction
Elders 
Children 
Homeless Shelters Food Programs
Worker's Rights
Community Organizing
Other Please explain:
   
Possible Summer Communities Locations
Rank your interest by 1, 2, 3, 4, 5, 6, 7 with 1 as little interest and 6 as great interest:  
  • Wellspring UCC/Migrant Ministry, Centreville, VA
  • Ellis Avenue Baptist Church, Chicago, ILL 
  • Metro Baptist Church, New York, NY
  • Hyaets, Charlotte, NC
  • Back Bay Mission, Biloxi, MS
  • Central St. Matthew UCC, New Orleans, LA
Please note other locations may also be available at the time of placement. 
   
How did you learn or hear about this program?
   
         
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Contact Information
Mary Schaller Blaufuss
Executive for Volunteer Ministries
Global Sharing Of Resources
Wider Church Ministries
700 Prospect Ave.
Cleveland,Ohio 44115
216-736-3214
blaufusm@ucc.org

Tonya Adams
Administrative Assistant
Partner Relations Ministry Team
Wider Church Ministries
700 Prospect Ave.
Cleveland,Ohio 44115
216-736-3216
adamst@ucc.org
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