~ Kairos III Application ~

February 17-19, 2017

Cornell/Ithaca College Catholic Campus Ministry

Thank you for your interest in the Kairos III Retreat, which will take place during the weekend of February 17-19, at Christ the King Retreat Center. Due to the limited number of spots available for Kairos III, we ask that you take the time to fill out the following application and reply with complete and well-thought answers to the questions found under the “Additional Information and Questions” section. Please attach your type-written responses for these questions to your application.

The cost for the weekend is $50 (scholarships are available). Further information regarding payment will be included with email reply to application. Please do not submit payment with your application.

  • COMPLETED APPLICATIONS CAN BE TURNED INTO MULLER CHAPEL (IC) OR ANABEL TAYLOR HALL (CORNELL) OR E-MAILED TO JEREMIAH ()
  • EARLY ACCEPTANCE DUE DATE IS FRIDAY JANUARY 27, 2017
  • EARLY SUBMISSION OF APPLICATION CAN AFFECT PARTICIPATION IN KAIROS II

GENERAL INFORMATION

______
Last NameFirst Name

______

Email AddressCell Phone Number

______

Residence Hall and Room Numberor off-campus address Student ID#

______

Expected Graduation Year

EMERGENCY CONTACT INFORMATION

______
Emergency ContactEmergency Contact Phone Number

(must be at least 18 years of age)

PARENT/GUARDIAN INFORMATION

______

NameEmailPhone Number

______

NameEmailPhone Number

HEALTH INFORMATION

Do you have any dietary restrictions and/or food allergies?Yes ______No ______

If yes, what? ______

Do you have any medical conditions that may affect your participation in the retreat weekend? Yes____ No____

If yes, please explain: ______

ADDITIONAL INFORMATION AND QUESTIONS

Please attach your type-written responses to the following questions and be as detailed as possible:

1)What attracts you to this retreat? Explain.

2)What do you hope to learn and how do you hope to grow from this retreat?

3)Do you consider yourself to be spiritual, religious, both, or neither? How has your faith and/or spirituality impacted your life?

4)Do you consider yourself an introvert (someone who tends to express and process ideas and emotions internally) or an extrovert (someone who tends to express and process ideas and emotions outwardly)? Explain. (If you are unsure, a close friend or family member can be of help.)

5)Have you attended a retreat in high school and/or college? Please list and describe.

6)Have you attended a Kairos retreat in high school? How was your experience?

7)How did you hear about Kairos?

8)Is there anything else you would like the Kairos team to know about you?

In order for you to fully enter into the Kairos retreat experience and remain present to fellow participants and student leaders, we will be limiting the use of technology (cell phones/laptops/iPods/Kindles, etc.) during this retreat. Ultimately, we ask you to do this for your own benefit and as a way to show respect to all in attendance. Is this something you would be able to sacrifice for the weekend?

Yes ______No ______

Kairos II participants will meet for departure at the Office of Campus Ministry at 4:15pm on Friday, February 17, and return to campus at approximately 4:30pm on Sunday, February 19. Can you commit to this time requirement?

Yes ______No ______

Participant Signature ______Date ______

IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT:

Jeremiah Deep, Campus Minister ()