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Chrysalis Verification Form

Please use this form to sumbit information about Youth Office and Chrysalis-related training you've attended.

You can check in the Chrysalis Manual (PDF, 16 pages) about how your hours count and add up, and you can check this list of all past trainings to jog your memory about names, dates, and places.

Note: Chrysalis only gives credit for each unique training experience. So for example, attending a Leadership Development Conference (LDC), being trained to lead an LDC, and leading an LDC would be three unique experiences, but attending two LDCs (or leading two LDCs) would not be considered two unique experiences.

We will collect these applications all year, and process them over the summer, so you should be able to start out each congregational year in August with a new Chrysalis Recognition you can be proud of!!

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Your Name:
Email Address:
Phone Number:
Address:

City:
State:
Zip:
Congregation:
Cong. City, State/Prov:
Please list the information pertaining to the Chrysalis-Related trainings you've attended.
Training 1:
Type of Training:
Your Role:
Trainer Names:
Date of Training (Month, Year):
Location (City/State, District):
Training 2:
Type of Training:
Your Role:
Trainer Names:
Date of Training (Month, Year):
Location (City/State, District):
Training 3:
Type of Training:
Your Role:
Trainer Names:
Date of Training (Month, Year):
Location (City/State, District):
Training 4:
Type of Training:
Your Role:
Trainer Names:
Date of Training (Month, Year):
Location (City/State, District):
Training 5:
Type of Training:
Your Role:
Trainer Names:
Date of Training (Month, Year):
Location (City/State, District):
Training 6:
Type of Training:
Your Role:
Trainer Names:
Date of Training (Month, Year):
Location (City/State, District):
Training 7:
Type of Training:
Your Role:
Trainer Names:
Date of Training (Month, Year):
Location (City/State, District):
Training 8:
Type of Training:
Your Role:
Trainer Names:
Date of Training (Month, Year):
Location (City/State, District):
Total Hours of Training:
Thanks so much for your dedication to YRUU and Youth Empowerment! We will process your request in the summer and you should receive all your materials by August.

For more information contact youth @ uua.org.

Last updated on Friday, April 18, 2008.