Jedi Gatherings Group

Jedi Chapter Member/Leader Application Form


If you have any questions or concerns, please contact Moonshadow or Jedi Xhaiden by using the "Contact Us" form found on the home page of the website.

(Questions marked with an * are required.)




  Today's Date
     


Background Information

  Online Handle(s)
     


  *Real Name (First and Last)
     


  *Preferred Name or Nickname (what name you prefer to be called in real life)
     


  Gender

     Male
     Female


  Age
     


  *Birthday (Month/Day/Year)
     


  *E-Mail Address
     


  Street Address
     


  City/Town
     


  *State/Province/Territory
     


  Zip Code
     


  *Country
     


  Home Phone Number            Cell Phone Number
              


  YIM
     


  AIM
     


  MSN
     


  ICQ
     


  Skype
     


Chapter Member Information


  *Chapter(s) to which you are applying
     


  Please list below any skills, lessons, or teachings you feel you can share with fellow Chapter members. (Chapters are designed for people of all levels, so if you do not feel ready to share anything at this time that’s ok. But also keep in mind that you each person is unique and most likely has something new they can bring to the group, even if they don’t feel as advanced in other areas.)
     


  If applicable, please list your qualifications for the items listed above.
     


  Please list any subjects, activities, or areas of study you are interested in focusing on in the Jedi Chapter.
     


  Physical resources you may be able to provide or share with fellow Chapter Members (dojo, sparring equipment, kendo sticks, etc.)
     


  *By submitting this application, I ascertain that I meet the necessary age requirements for the Jedi Chapter. (18 or older for a regular Jedi Chapter. Under age 18 for a Junior Chapter member.)

      Agree
      Disagree


  *I give consent for the background information listed above to be shared with the Chapter Leader of the Chapter to which I’m applying. (This information will be used only to ensure age eligibility and to assist with notification of future Chapter meetings.)

      Agree
      Disagree


Chapter Leader Information


  *Desired Chapter Location (please be as specific as possible)
     


  *Type of Chapter

      Junior (Under age 18)
      Senior (Over age 18)


  *I am applying to be a

      Chapter Leader
      Co-Chapter Leader


  Name(s) of Co-Chapter Leader(s), if applicable:
     

  *Chapter Focus (If applicable) (energy healing, martial arts, volunteerism, etc.)

     

  *Please describe in detail why you want the Chapter Leader position.

     


  *Please describe in detail what you feel qualifies you for the Chapter Leader position and how you plan to fulfill your duties.

     


  *I have carefully read and reviewed the requirements and duties of a Chapter Leader and agree to fulfill them to the best of my ability if granted the position. I hereby request to apply for that position in the above stated Chapter.

      Agree
      Disagree


  *I give consent for all information submitted in this form to be shared with the members of the Chapter Leader Review Board in order to assist with the Chapter Leader interview and approval process.

      Agree
      Disagree


  *I give consent to be contacted and interviewed via in-person, telephone, and/or through online mediums by members of the Chapter Leader Review Board and have provided the necessary contact information above.

      Agree
      Disagree


  *Please list what times and dates you are available to be interviewed.

     


  * Please check all the methods you are available to be interviewed by. (If you wish to be interviewed by those methods you must provide that information in your Jedi Registry submission form. Phone and voice chat are the preferable methods for most Council members.)

      Phone
      Skype
      AIM
      YIM
      MSN
      ICQ
      Email


  *I own a microphone for voice chat.

      Yes
      No


Background Check


PLEASE NOTE: In order to ensure the safety of the Chapter Members, the Chapter Leader Review Board will be conducting background checks on all Chapter Leader applicants. To conduct this background check, you must submit the following information to Leo Dorsey at leodorsey@aol.com. No one will have access to this information other than Leo Dorsey.

Full Name:
Full Birth Date:
Social Security Number:

By submitting the above information, you are giving your consent for a background check to be preformed and for any information that comes up in the background check to be posted in the private Review Board forum viewable to all Review Board Members and Alternates. This information will not be shared with anyone outside the Review Board and will be held in the greatest confidence. If you do not feel comfortable sharing this information, please express any concerns with Moonshadow at Moonshadowlight5@gmail.com.


  *I give my consent to submit to a background check in order to help ensure the safety of the Chapter Members.

     Agree
     Disagree