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Summer Young Adult Service Communities Application

 Part I Application

Questions?

Extended Application Period - Apply Today!

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 Young Adult Service Communities do not discriminate against applicants on the basis of religion, race, color, national origin, sex, age, sexual orientation, or disabilities.

********************************************

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 
   
Your Availability for a Young Adult Service Communities Placement 
 June - August 2010 - Young Adult Service Communities
(September 8, 2010 - July 31, 2011-UCC Companion Communities)		  
   
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: 
   
Possible Service Settings
(Indicate interest by 1, 2, 3, 4, 5 with 1 as little interest and 5 as great interest.)
Immigration & Border Ministries 
Inner City Ministries 
Elders 
Children 
Homeless Shelters Food Programs
Food Programs
Worker's Rights
Direct Social Service
Community Organizing
Other Please explain:
   
Summer Communities Locations 
  • Good Shepherd UCC, Sahuarita Valley, AZ
  
  • Ellis Avenue Baptist Church, Chicago, ILL 
  
  • Metro Baptist Church, New York, NY
  
  • Pullen Memorial Baptist Church, Raleigh, NC
  
  •  Back Bay Mission, Biloxi, MS
  
  •  Nu-Vizion UCC, Toledo, OH
  
       

 

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