Kairos Volunteer Application Complete and return to: Kairos Prison Ministry of Ohio, P.O. Box 14490, Columbus Ohio 43214 Or email as attachment to: [email protected] ...I was in prison and you visited me.” Matthew 25:36 Date (mm/dd/yy): ____/____/____ Male Female Age at least 18: Yes No Name: Prefix _____ Full legal name _______________________________________ Suffix: ______ Preferred (nick) name: __________________________ Race: African American Asian Caucasian Hispanic Native American Other ____________________________________ Home address 1: _____________________________________________________________________ 2: _____________________________________________________________________ City: ___________________________ State Abrev: _______ Zip: ________-________ County: _________________________ Phone: Home (____ ) _____-________ Cell (____ ) _____-_________ Fax (____ ) ____-__________ Preferred email address: _______________________________________________________________ Religion: Denomination (e.g. Catholic, Lutheran, etc.) ________________________________________ Worship Church __________________________________ City/State: _______________/__________ Are you: Clergy? Yes No If “Yes”, place of employment? _______________________ Musician? Yes No If “Yes”, what instrument? __________________________ Have you attended a qualifying Christian renewal weekend? Yes No (strongly recommended prerequisite to serving on Kairos) If “Yes”, which number? 1. Catholic Cursillo 8. High School Catholic Kairos 2. Christ Renews His Parish 9. Koinonia 3. Chrysalis Youth Weekend 10. Lutheran Via De Christo 4. Cum Christo 11. The Great Banquet 5. Walk To Emmaus 12. Tres Dias 6. Episcopal Happening Youth Weekend 13. The Great Banquet 7. Episcopal Cursillo 14. Other: _______________________________________________________________ If “Yes”, Weekend number: _____ Year: _____ City/State: _______________/__________ If “No”, would you like us to recommend one? Yes No If “Yes”, which number? Page 1 of 2 Kairos Volunteer Application Do you have a preferred Institution at which to serve? If “Yes”, which number? 1. Allen Correctional Institution (NCI), Lima 2. Dayton Correctional Institution (DCI), Dayton 3. Hocking Correctional Institution (HCF), Logan 4. Circleville Juvenile Correctional Facility (CJCF) Circleville 5. Kairos Torch at Scioto Juvenile Correctional Facility, Delaware 6. Lebanon Correctional Institution (LeCI), Lebanon 7. Marion Correctional Institution (MCI), Marion 8. Kairos Outside (MCI), Marion 9. Kairos Torch at Marion Correctional (MCI), Marion 10. North Central Correctional Complex (NCCC), Marion 11. North Central Correctional Complex Torch (NCCC), Marion 12. Northeast Pre-Release Center (NePRC), Cleveland 13. Oakwood Correctional Facility (OCF), Lima 14. Ohio Reformatory for Women (ORW), Marysville 15. Ohio State Penitentiary (OSP), Youngstown 16. Pickaway Correctional Institution (PCI), Orient 17. Ross Correctional Institution (RCI), Chillicothe 18. Southern Ohio Correctional Facility (SOCF), Lucasville 19. Toledo Correctional Institution (ToCI), Toledo 20. Trumbull Correctional Institution (TCI), Leavittsburg 21. Warren Correctional Institution (WCI), Lebanon Preferred Ministry Focus: Kairos Inside Kairos Outside Torch Unsure Check items of interest: Attend Kairos Weekend Closing Write Letters Recruit Volunteers Make Posters/Placemats Serve on a Team Prayer Logistic Support Phone committee Monetary Support Assist Ex-Offender Reentry Bake Cookies Questions? ______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ A Kairos Representative will contact you ASAP. Thank you and may God bless you abundantly! Page 2 of 2 .