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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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Personal Information
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
Total Hours of Training
Submit
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.

This work is made possible by the generosity of individual donors and congregations. Please consider making a donation today.

Last updated on Thursday, October 25, 2012.

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