Summer CUP
InterVarsity Chicago Urban Program
Thank you for your interest and desire to participate in the summer mission of the Chicago Urban
Program (CUP). We appreciate your commitment to learn more about urban ministry, ethnic identity
and reconciliation, compassion, team building and servant leadership. We know that your pursuit of
these issues will help you grow spiritually and be a more effective witness for Jesus Christ.
Enclosed you will find a copy of the CUP application. First deadline is April 12. If you will not make
this deadline, please contact us and tell us when you will get in your application. We will accept
applications until the program is full.
Please email your information to Jazzy Johnson at jazzy71391@gmail.com when you begin your
application so that we know you are applying and to follow up with you.
There are 5 major components of the summer internship program.
1. Training - Learning together about the Gospel’s redemptive message about ethnic identity,
poverty, and injustice through discussions, devotionals, testimonies, teaching, and experience
in the community.
2. Service - Partnering with and learning from ministries in the community through deep
relationships over time.
3. Community - Students and staff growing together through communal spiritual disciplines,
living and working in community, and learning to manage conflict.
4. Spiritual Disciplines – Relating with God and God’s people through worship, prayer,
reflection, group process, weekly ROS, prayer partners, staff 1-on-1s, and debriefing retreats.
5. Neighborhood/Church - Community involvement by building relationships and expanding our
comfort zones through community outreach.
Summer expectations
The CUP summer mission experience involves your full commitment during the day and evening and
on weekends.
● Personal events cannot be scheduled during the CUP dates (weekends or evenings)
without permission from CUP director before your arrival.
● Because relationship building with people in the community and CUP team members is
a priority and is time demanding there will be:
- limits on use of email
- limits on phone use
- limits on visitors
- limits on trips away from the community during the summer.
See Technology and Community below
Dates: Tues June 23 morning to Weds Aug 12 evening
Potential Partners:
1. Austin: Circle Urban Ministries and Rock of Our Salvation Free Church (118 N. Central Ave
Chicago, IL 60644)
Austin is a primarily African American neighborhood on Chicago West Side at N. Central and
Washington. We will be working with the kids in their Camp Usoni program as teachers for this
enrichment day camp. Circle Urban’s website is www.circleurban.org (this site is subject to change).
2. Hermosa/Humboldt Park: Grace and Peace Church (2100 N. Kildare Chicago IL 60639)
In the Hermosa neighborhood of Chicago. The neighborhood is predominately Puerto Rican. Grace
and Peace Community’s website is www.graceandpeacecommunity.com/. We will work with a variety
of social service organizations in Humboldt Park. (this site is subject to change)
3. Lawndale: Lawndale Community Church (3827 W. Ogden Ave., Chicago, IL 60623)
(Priority will be given to Northwestern University (IL) students for this team)
North Lawndale is primarily African American neighborhood on Chicago's West Side near the
intersection of Pulaski and Ogden. The Lawndale Community Church website is:
www.lawndalechurch.org. (this site is subject to change)
a) Lawndale: The Garden sub-team
One team will be working with their academic day camp The Garden. We will serve as coteachers alongside of people from the neighborhood to help kids with basics schools skills.
b) Lawndale: Community Development sub-team
A second team will work with the different community development organizations in Lawndale.,
These may include Health Clinic, Legal Clinic, Development Corporation, The Firehouse (arts),
and other ministries started by the church working as an intern on projects, administrative
support, and shadowing co-workers.
Housing:
You will be housed in apartments on the west side of Chicago within walking distance of your work
site and/or church. You will be living in community with your site team and an onsite staff. It is highly
likely that this will be a co-ed apartment due to the difficulty of finding short-term housing.
Technology and Community:
As part of the invitation to live with your neighborhood team and with your neighbors, we will have a
fast from technology (internet, cell phone, email, etc.). You will have time once a week to send email,
get on the internet, and use your cell phone to contact family and friends. We do this in order to help
build relationships in your neighborhood and to keep us engaged in what is happening at CUP.
Expenses:
The cost of housing, food and program is $1725.
It is expected that you will find people and churches to financially support your summer mission
experience. Money that is given beyond your needs will be used to help the funding needs of other
CUP students and for CUP expenses not covered by the base price. We also expect that you will ask
people to pray for you.
You can also seek additional support for a stipend (up to $3,000 before taxes). If you are interested in
raising additional money for the stipend you must let us know when you are accepted in late May. For
more on raising a stipend please email Beth at izbe@aol.com.
Application Deadline:
The first application deadline is April 12. We will take applications after that until the program is full.
Please make sure that all of your references are emailed directly to the CUP Registrar Jazzy Johnson
at jazzy71391@gmail.com. They can also be mailed to her at 1841 N Monticello #2W, Chicago IL
60647
We pray that you will have a clear sense of God's leading and direction in your life as you make
decisions about your summer. If you should need any further information, please feel free to call or email.
Grace and Peace, The CUP Team
Email all applications and questions to: Jazzy Johnson jazzy71391@gmail.com (817) 657-4745
InterVarsity Christian Fellowship
Chicago Urban Program - Summer Mission Application
Please fill in info and email to the CUP registrar Jazzy Johnson at jazzy71391@gmail.com
Today’s Date
I am interested in these Summer CUP sites. Feel free to highlight multiple programs.
These options may change once we make final decisions for this summer.
Austin: Camp Usoni
Lawndale Community Development (circle all interests)
Clinic, Legal, Development, Arts
Lawndale: Garden
We may also ask you to consider a different program due to team and program dynamics.
Personal info
Name:
Date of Birth: (mo/dd/year)
Ethnicity:
School:
Sex:
Major:
Check your level in college in the spring of this school year:
Fr
So
Jr
Sr
Grad Student
I can work legally in the United States? Yes
No
Present or School Address
Street:
Cell Phone:
City, State and Zip:
Permanent E-mail address:
Alternate E-mail address:
Dates at above address:
Permanent Address:
Street:
City, State and Zip:
Parents’ or Guardians’ names:
Church:
At school
Name of church:
Address:
or at home
Head Pastor:
Present Involvement:
Home Phone:
Special Interests
Please list your special interests and hobbies:
Activities: Extra curricular or campus activities (including social, honorary groups, government, etc.)
Work Experience
Position held
Place
Date
Duties
Languages
What foreign languages have you studied? How well can you can you converse?
Language
Number of years
Conversation Rating (fluent, needs known, poor).
References
Who did you give the 4 reference forms to
(if you have questions about who to give these to, contact Jazzy at jazzy71391@gmail.com or (817)
657-4745)
1. IVCF Staff or Campus Minister:
2. Peer/Roommate:
3. Pastor:
4. Parent/Guardian:
Summer Agreement
I agree to abide by the limitations set by CUP on such things as cell phone use, email use, trips away,
number of visitors, etc. Yes ______ No ________
I agree to work in cooperation with the CUP summer staff and to abide by their decisions.
Yes _____ No________
Comments or concerns:
Do you have any trips or weddings planned during CUP? When?
Health Information
1. When did you last have a complete physical exam? Year:
2. Appraise your present health.
Great
Fairly good
Some difficulties (please explain)
3. Height
Weight (Optional)
4. Any chronic ailments? No
Yes
If yes, please explain:
5. Any physical conditions which might require attention or modification of your workload?
6.
List any serious physical or mental illness that you have had.
Year and condition:
Year and condition:
Year and condition:
7. Do you have a doctor? Yes No
Are you currently actively under care? Yes
If under active care - doctor’s name
Address
8. Are you in need of a special diet? Yes
If yes please describe
No
Phone
No
IVCF CHICAGO URBAN PROGRAM
Last (Family) Name:
First Name:
Date:
INDIVIDUAL RELEASE AND CONSENT
1. In consideration for being accepted and allowed to participate in this conference/project and
activities associated with its program and location, I personally assume responsibility for my actions,
and release InterVarsity Christian Fellowship/USA (hereafter InterVarsity), its Trustees, employees
and agents from loss, injury or damage to myself or my property; provided that nothing contained
herein shall excuse InterVarsity, its Trustees, employees or agents from responsibility to act with
reasonable care for the safety of myself or my property.
®
2. I give permission to InterVarsity to be photographed, recorded, and/or video taped and to allow
this material to be used for publicity.
3. I give permission to InterVarsity to obtain medical assistance in the event of an emergency. This
permission will include the administration of medicines, surgical treatment, X-ray examination or
hospitalization as might be ordered by a licensed medical doctor. I release and discharge
InterVarsity, its Trustees, employees, and agents from any liability for any first aid rendered or
treatment performed pursuant to this consent.
4. I understand that InterVarsity has a hostage policy that states that InterVarsity should not yield to
demands, including the payment of ransom or other extortion, issued through the use of hostage
taking or extortion.
5. If I am under age 18 (if you are, please check here
) I state that I am a mature minor (of
college age and living away from parent/guardian) and have the capacity to consent to the terms of
this Release.
For persons under the age of 18 (19 in Alabama) and NOT living away from parent/guardian: I, the undersigned parent or legal
guardian of the above person, consent to that the above named person’s participation in this activity and agree to the terms of this
release.
Parent or Guardian Signature
Name (printed)
Date Signed
6. Any claim or dispute arising from or related to this release shall be settled by mediation and, if
necessary, legally binding arbitration in accordance with the rules of a mutually agreed upon
alternative dispute resolution service, subject to provisions of federal, State and local law governing
arbitration, including, but not limited to jurisdiction and allocation and payment of costs. Judgment
upon an arbitration decision may be entered in any court otherwise having jurisdiction. These
methods shall be the sole remedy for any controversy or claim arising out of this agreement and the
parties expressly waive any right to file a lawsuit in any civil court for such disputes, except to enforce
an arbitration decision.
7. I agree to furnish the following background information: (please circle or highlight your answer)
(If you live in a state whose law exempts you from answering any of questions 1 through 6 below, you
need not answer such question(s). For example, in certain states, such as Colorado. Illinois, Ohio,
Oklahoma or Rhode Island, if you are the subject of a conviction or an arrest contained in a sealed or
expunged record, you may respond “no” to question 1 as to such a conviction or arrest. Also, as a
further example, if you lived in a state which exempts you from providing arrest information, such as
Michigan, Illinois, New York, Rhode Island, Washington or Wisconsin, do not answer question 2.)
1. Have you ever been convicted of a criminal offense (felony or misdemeanor, except for
minor traffic violations)? You will need to answer “yes” if you have entered into a plea
agreement, including a deferred sentence or deferred judgment arrangement, in connection
with a criminal charge.
If you have been convicted of such an offense, please attach a statement or explanation
including the nature of the offense, date, court where conviction was entered and any other
relevant information.
Yes No
Leave the right answer and delete the wrong answer
2. Have you ever been charged with a sexual offense, crime of violence or offense relating to
children?
If you have been charged with such an offense, please attach a statement or explanation,
including name of the offense charged, date, law enforcement agency making the charge and
any other relevant information.
Yes No Leave the right answer and delete the wrong answer
3. Have you ever been reported to a social services agency, law enforcement authority, child
abuse registry or similar organization regarding abuse or misconduct involving children?
If so, please provide a description of the circumstances and the name and address of the entity
receiving the report.
Yes No Leave the right answer and delete the wrong answer
4. Have you ever been subjected to expulsion, reprimand or other discipline by a church,
denomination or other religious organization, including InterVarsity?
If so, please describe the circumstances and provide the name and address of the church,
denomination or religious organization involved.
Yes No Leave the right answer and delete the wrong answer
5. Have you ever been dismissed from employment by any employer, including InterVarsity
and/or other charitable and religious organizations, following an allegation of sexual
misconduct or other immoral or inappropriate behavior or conduct?
If so, please describe the circumstances and provide the name and address of the employer.
Yes No Leave the right answer and delete the wrong answer
6. Have you ever been the subject of an investigation or allegation of sexua1 misconduct,
sexual harassment or other immoral behavior or conduct involving adults or children?
If so, please describe the circumstances and provide the name and address of the employer,
educational institution, church or other organization where the investigation, review or
complaint occurred.
Yes No Leave the right answer and delete the wrong answer
If you checked “yes” to any question above, please provide a complete explanation of the
circumstances. If you feel there are any extenuating circumstances, such as your age at the time,
please so state. In order to provide a full explanation of an affirmative response, you may attach
additional pages to this questionnaire. InterVarsity will evaluate what you have written and may ask
you to provide additional information. In addition, InterVarsity may determine that it needs to conduct
an investigation and may require your assistance with this. This investigation may include a
background screening including, but not limited to, the following: National Criminal Database, Social
Security Search, National Sex Offenders Registry, and Motor Vehicle Records. While checking “yes”
to any of the questions above will not result in automatic disqualification or termination from
InterVarsity, InterVarsity may determine that an affirmative response would make an individual unfit
for service or association with InterVarsity’s ministry. In all cases, InterVarsity reserves the right to
determine, at its discretion, what action should be taken.
If any of your responses or information provided on this form are untruthful or inaccurate, InterVarsity
may determine that you are no longer qualified to be associated with the ministry in any capacity.
By signing below, you agree that, if you become an employee or volunteer of InterVarsity, and
become involved in criminal proceedings or other circumstances that would cause your answers to
any of the questions above to change, you will immediately notify, and provide a complete description
of the circumstances, to the Director of Human Resources of InterVarsity.
Signature for consent form
(if sent via email signature is name and zip)
Name printed
Emergency Contact (Print Name)
Emergency contact relationship with you?
Emergency contact cell phone
Emergency contact work phone
Health Insurance Company name, policy holder name and policy number covering participant:
Or I do not have health coverage
If any of your responses or information provided on this form are untruthful or inaccurate, InterVarsity
may determine that you are no longer qualified to be associated with the ministry in any capacity.
ESSAY QUESTIONS (Use additional space or paper as needed)
A. SPIRITUAL/PERSONAL LIFE
a. In your own words, express your current relationship with Jesus Christ.
b.
What is your story or testimony about your life with Jesus? That is what is your background,
Christian experience, and significant factors that have contributed to your spiritual growth and
development as a Christian.
c.
What do you believe to be your spiritual and/or ministry gifts?
d.
Describe what you believe to be several of your strengths and weaknesses. What are you
actively doing to cultivate your strengths and to address or overcome your weaknesses?
e.
Give a recent example of a conflict with a person in authority or a peer. How did you deal with
these conflicts?
f.
List other skills or special talents (drawing, drama, writing, musical abilities, math, science, etc.)
B. EXPECTATIONS AND GOALS
a. Why do you want to participate in the Summer Chicago Urban Program? What do you hope to
gain from this experience?
b.
A friend asks you what you will be doing this summer at CUP – what do you tell them?
C. CROSS-CULTURAL AWARENESS AND EXPERIENCE
a.
What courses or experiences have helped you understand United States’ cultures or sub-cultures
other than your own?
b.
What is the current ethnic make-up of your campus? Your IV chapter or campus ministry group?
Your church?
c.
What experiences have you had in cross-cultural relationships? (E.g. friendships, travel or
overseas residency, etc.)
d.
What do you see as the three biggest barriers to effective cross-cultural communication?
D. CHRISTIAN COMMUNITY ON CAMPUS
a. Describe your involvement with InterVarsity Christian Fellowship (or other campus ministries).
b.
What campus ministry sponsored training events have you attended (please describe briefly) and
what leadership positions have you held in your campus ministry. Do you have any experience
discipling others? If so, please describe.
c.
Your participation in the summer mission should influence your ministry next year. Describe some
ways you might take your summer experience back to your life and campus.
E. DEVELOPING A SUPPORT TEAM
This section is to help you start thinking and praying whom God may call to pray and support you. We
believe that if the Lord has called you to participate in Summer CUP that God will supply the
necessary support needed.
An InterVarsity staff worker or missionary is a great resource for this section as they do this for a
living – feel free to get their help. You will receive further materials to help in this process.
Pray and ask the Lord to show you who would be interested to hear about your summer plans,
regardless of what you think is their ability to give or not. Think about your church, school friends,
relatives, people back home, campus ministry alumni, etc. Feel free to list more than 20 since this will
be where you will start your support raising.
b.
Your list
Name
Email
Phone
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
a.
c.
Write the introductory paragraph of your support letter (explanation below)
Dear friend…
The support raising process is often done through a letter or email to people asking them for their
help. Write the introductory paragraph of your support letter. This paragraph is usually the update on
your life and you might mention events that lead you to considering CUP. (I.e. I went to this IV training
event and wondered what I might do this summer to explore God’s heart for the world… OR I am
involved with InterVarsity on campus and was recently challenged to ...)
Applicants’ signature
(If sending via email – name and zip code)
Date
Email application, health info and consent form to: CUP Registrar, Jazzy at jazzy71391@gmail.com .
First deadline April 12. Applications accepted after that until program is full.
Peer or Roommate Reference form
InterVarsity Christian Fellowship - Chicago Urban Project
Reference for
who is being considered as a participant in InterVarsity’s Chicago
Urban Program, a summer missions program with InterVarsity Christian Fellowship. It would most
helpful to both the applicant and InterVarsity if you would be completely frank. Many of the questions
have to do with placement rather than acceptance or rejection. Thank you for your help!
1. How long have you known this person, and in what capacity?
2. In what ways have you seen his/her Christian beliefs influence their lifestyle and attitudes?
3. Please describe the applicant’s character in the area of:
a. Teachability:
b.
Servanthood:
c.
Response to authority:
d.
Team player:
e.
Flexibility:
f.
Dealing with conflict and disagreement:
4. What are the applicant’s major strengths and weaknesses?
5. Participation in the Chicago Urban Program requires spiritual, emotional, and relational maturity
due to the intensive nature of this program. Please comment on this person’s maturity level.
6. How does this person respond to unfamiliar people in an unfamiliar environment? What actions
and/or reactions have you observed?
7. Looking over the following categories, in which areas does the applicant need to grow most?
Please comment on all that apply so that we can better support this person over the summer.
a.
Lacks some social skills (consider things like shyness, tact, initiative, patience, etc.)
b.
Sometimes lacks common sense.
c.
Sometimes is overly sensitive.
d.
Sometimes has difficulty with authority.
e.
Sometimes is unteachable or inflexible.
8. Why do you think the applicant wants to participate in the Chicago Urban Program?
9. Additional comments.
Thank you for your time and thought in completing this reference. It is appreciated!
Print name and zip code (as an electronic signature)
Telephone #
E-mail
Please email or mail by the deadline the applicant has given you
to Jazzy Johnson jazzy71391@gmail.com
1841 N Monticello 2W, Chicago IL 60647
817-657-4745
IVCF Staff and/or Campus Minister Reference Form
InterVarsity Christian Fellowship - Chicago Urban Program
Reference for
who is being considered as a participant in InterVarsity’s Chicago
Urban Program, a summer missions program with InterVarsity Christian Fellowship. It would most
helpful to both the applicant and InterVarsity if you would be completely frank. Many of the questions
have to do with placement rather than acceptance or rejection. Thank you for your help!
1. How long have you known this person, and in what capacity?
2. In what ways have you seen his/her Christian beliefs influence their lifestyle and attitudes?
3. How involved are they in your campus ministry? In what roles and capacities?
4. Participation in the Chicago Urban Program requires spiritual, emotional, and relational maturity
due to the intense nature of this program. Please comment on this person’s maturity level.
5. What areas of weakness or need for growth do you perceive in this applicant?
6. Please describe the applicant’s character in the area of:
Teachability:
Servanthood:
Response to authority:
Response to conflict:
7. Have you counseled the applicant for any personal problems that may affect them in an intense
and cross-cultural setting? If yes, please explain.
8. Why do believe this person wants to participate in the Chicago Urban Program?
9. Would you enthusiastically accept this student on your team if you were taking a team overseas?
Why or why not?
10. Student often find the support raising process difficult.
Please list 10 alumni from their school or chapter or other donors you know who would welcome
being asked to support a student at Summer CUP, ideally at the $50-100 level. Thanks.
Will your fellowship be taking an offering for students from the chapter who are going on summer
missions trips?
Yes
No
Name
1
2
3
4
5
6
7
8
9
10
Email
Phone
Helpful info on them?
10. Additional comments:
Thank you for your time and thought in completing this reference. It is appreciated!
Print name and zip code as electronic signature
Telephone #
E-mail
Please email or mail by the deadline the applicant has given you
to Jazzy Johnson jazzy71391@gmail.com
1841 N Monticello 2W, Chicago IL 60647
817-657-4745
Parent/ Guardian Reference Form (1 page)
FAQ for Parents (2 pages)
InterVarsity Christian Fellowship - Chicago Urban Program
Reference for
, who is being considered as a participant in
InterVarsity’s summer mission with the InterVarsity Christian Fellowship Chicago Urban Program
(CUP).
All parents or guardians of the applicants for Summer CUP are asked to answer the following
questions.
1. What do you know about this summer mission program? What else would you like to know?
2. How do you feel about your son/ daughter’s desire to participate?
3. Have you received the “Summer CUP FAQ for Parents” Yes
You can download it at www.cupivcf.org
No
Thank you for your time and thought in completing this reference. It is appreciated!
Print name and zip code as electronic signature
Telephone #
E-mail
Please email or mail by the deadline the applicant has given you
to Jazzy Johnson jazzy71391@gmail.com
1841 N Monticello 2W, Chicago IL 60647
817-657-4745
Summer CUP FAQ for Parents
What about safety?
CUP students and staff will be housed in apartments rented near their service sites and
churches on Chicago’s Westside. We have been working on the West side of Chicago since
1984. They will be housed with other CUP students. Due to the extreme challenge of finding
short terms rentals for the summer it is very likely that these apartment team will be co-ed with
separate men’s and women’s bedrooms. There will be an on site InterVarsity staff or volunteer
living with each of the teams as a leader and supervisor.
During the past twenty years CUP has never had any major problems with participants being
unsafe during the summer program. We encourage students to use caution and to avoid
situations that could be unsafe. They are expected to travel in pairs and groups and to notify
members of their house where they are going and when they plan to return. We will place
limits and curfews on when they can be out and where they can go. This form of accountability
has worked well for us in the past and we expect another safe summer.
We do not recommend bringing a car. If a student does bring a car it needs to be insured. It
needs to be locked when not in use, with anything valuable out of sight. IVCF cannot be held
responsible for the loss of or damage to personal property.
What will summer CUP students be doing?
In Austin and Lawndale students will spend Monday through Friday (morning and afternoon)
working in day camp programs run by the churches we partner with. They will be teaching kids
alongside of teachers from the community in a structured program. In Humboldt Park students
will be working with the local church in their morning kids program and serve in various social
services (food pantry, clothing closet, etc.) the church offers.
Evenings will include team suppers prepared by CUP students and staff. After supper different
nights will be set aside for training, debriefing the day, fun with the team, special activities with
the church, personal time, etc.
Weekends will include some of these activities: Special activities with the church, spending
time with people in the neighborhood, house bible study, a group teaching, a general house
meeting, worship, relaxation, reading, extra rest, fun, exploring the city, laundry, etc. Sunday
worship will be with our partnership church in the neighborhood followed by reflection time in
the afternoon.
How do I contact my daughter/son?
For mail or care packages
Austin team:
InterVarsity - CUP Student’s name,
c/o Circle Urban Ministries 118 N Central Ave Chicago IL 60644
Humboldt Park team:
Student’s name
c/o GAP church 2100 N. Kildare Ave. Chicago, IL. 60639
Lawndale team:
InterVarsity-CUP Student’s Name
c/o Lawndale Community Church 3827 W. Ogden Chicago, IL 60623
Cell phones are often a distraction so we will be asking students to mainly not use their cell
phones during their time at CUP. You can expect to hear from them via phone once a week, at
the most. They also will have limited email access so expect to hear from them once a week
via email, at the most.
If you would like to visit, have your son/daughter talk to CUP staff before the program starts so
that your visit can be set up beforehand to work with the rest of the schedule. Thanks.
In case of an emergency
During the program please call the CUP staff for your student’s team, and we will contact the
student so they can call you back. Once teams are assigned you will be given the onsite staff
leaders info.
Jazzy Johnson at jazzy71391@gmail.com (817) 657-4745
Contact re: logistics, finances, travel arrangements, overall questions about the program,
What about arrival and departure?
Arrival: Tues. June 23 by 11:00 AM (Central time) Students can arrive via plane, train or bus
and we will pick them up. They can also be dropped off (details to follow on exact location for
arrival)
Departure: Weds Aug 12 after 3 PM (Central time). We will transport them to the airport, bus or
train station as needed.
What if I have more questions?
Feel free to contact Jazzy Johnson by phone or email if you have more questions.
Your son or daughter will receive a more extensive information packet and it may help answer
your questions too.
We are anticipating that this summer will be a great experience for your son/daughter. Thanks for
your support of them as they seek to learn and grow in their understanding of God’s Kingdom and the
issues of multi-ethnicity, racial reconciliation and justice.
For the entire CUP staff team
Jazzy Johnson
jazzy71391@gmail.com
(817) 657-4745
Pastor Reference Form
InterVarsity Christian Fellowship
Chicago Urban Program
Reference for
, who is being considered as a participant in
InterVarsity’s Chicago Urban Program, a summer missions program with InterVarsity Christian
Fellowship. We want very much for the local church to be involved in the acceptance, sending, and
ongoing spiritual support of our applicants. It would most helpful to both the applicant and
InterVarsity if you would be completely frank. Many of the questions have to do with placement rather
than acceptance or rejection. Thank you for your help!
1. How long have you known this person and in what capacity?
Less than 6 months
1-2 years
more than 5 years
7-12 months
3-5 years
Capacity: __________________
2. How involved have they been in your church?
Very involved
1
2
3
Uninvolved
5
4
Capacity (s): _____________________________________________________________
3. To what extent would you consider them grounded in their Christian beliefs and knowledge of the
Bible?
Well grounded
1
2
3
4
Not well grounded
5
4. What gifts for ministry have you perceived in the applicant?
5. Additional comments:
Thank you for your time and thought in completing this reference. It is appreciated!
Print name and zip code as electronic signature
Telephone #
E-mail
Please email or mail by the deadline the applicant has given you
to Jazzy Johnson jazzy71391@gmail.com
1841 N Monticello 2W, Chicago IL 60647
817-657-4745