Attachment 2 (Sample) KAIROS PRISON MINISTRY INTERNATIONAL INC., (State)

NOMINATION FORM FOR KAIROS WEEKEND LEADERS To be completed by the Advisory Council The __________________________________________________ Advisory Council nominates; Nominee’s Name: ____________________

Phone Number: __________________________

Street Address: ________________________ E-mail:_________________________________ City/Town: _______________________

State: ___________

Zip: _______________

Occupation: ______________________ Work/Office Phone # : _______________________ Denomination: _______________ Worships At: ______________________________________ Kairos Experience: ______________________________________________________________ ______________________________________________________________________________ Interviewed by the Advisory Council on: ________________________ Advisory Council Member’s Comments: ___________________________________________ ______________________________________________________________________________ Kairos Talks Given: _________________________________________________________________ Has this nominee led a prior Kairos Weekend? Yes _____

No _____

Nominee’s Attendance Record at past Team Building Meetings? _________________% I have been briefed on the requirements for being a Weekend Leader, including Advanced Kairos Training (AKT) and the Planning Guide for Leaders using EZRA and will comply with those requirements. _________________________________________ Signature of Nominee/Weekend Leader Served (or will serve) as Observing Leader: on Kairos _____ Date: ______________________ If approved will serve as Leader of Kairos ______ Date: ___________________________ Advisory Council Chair: _________________________________ / ____________ Signature Date Action By (State) Committee: Approved ___________Disapproved _____________ State Chair: _______________________________________ / ______________ Signature Date

Weekend Leader Nomination Form for - MyKairos

Signature of Nominee for Weekend Leader. Advisory Council Chair Signature: Date. Approved By (State) Committee: Y N . State Chair Signature: ...

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