Confidential DTS Application

Guide to Completing the
Discipleship Training School
Application
We want to thank you for your interest in our school! We pray God will give you wisdom and guidance as
you fill out this application. If you have any questions, please contact us. Thank you for considering YWAM maui
in your future plans. God bless!
HOW TO COMPLETE THIS APPLICATION:
All of the following forms must be submitted with all applicable questions answered before a decision will be
made. If a question does not apply, write “N/A” in the space provided. Husbands and wives enrolling as students
must complete separate application forms. If you need more space to answer a question, please use a separate
sheet of paper.
REFERENCES:
Enclosed with this application are three reference forms, which need to be sent to the references that you have
selected (one friend, one teacher/employer, and one spiritual leader). Fill in your name, address, and school
dates for the DTS, and then give the forms to three references. Please ask that they return the forms directly to
us in a sealed envelope, as soon as possible.
ADMINISTRATION FEE:
A non-refundable fee of $70.00 US (which covers the cost of processing your application) must be included when
you return this form.
UPON RECEIPT OF THE COMPLETED (INCLUDING PHOTOS AND REGISTRATION FEE) APPLICATION AND
REFERENCES, YOUTH WITH A MISSION - MAUI WILL PRAYERFULLY CONSIDER THE APPLICATION AND
NOTIFY THE APPLICANT OF THEIR DECISION.
CHECKLIST:
_____Application Form
_____Health Form
_____Financial Form
_____Waiver of Liability and Release
_____Personal History
_____Outreach Privilege Acknowledgement & Agreement Document
_____Passport/Visa Information
_____Photos (2 Passport-Style Photos)
_____Registration Fee: $70 USD per individual - $100 USD for married couples
_____Reference Forms
_____Pastor/Spiritual Leader
_____Employer/Teacher/YWAM Leader
_____Friend
Please direct all forms and correspondence to:
Youth With A Mission - Registrar
PO Box 790237
Paia, Maui - HI
96779
Toll Free: 1-866-579-8402
Fax: (808) 575-9476
Email: registrar@ywammaui.com
SFMI Email: sfmi@ywammaui.com
Discipleship Training School
Confidential Application Form
1) PERSONAL INFORMATION:
Please include 2
passport-style
photos with this
application.
STARTING DATE OF DTS:_______________________
NAME: ________________________________________________________________________________________________________________
(Title, First Name, Last Name)
PERMANENT ADDRESS: _______________________________________________________________________________________________
_______________________________________________________________________________ COUNTRY: _____________________________
(Street/Box #, City, State/Province, Zip/Postal Code, Country)
CURRENT MAILING ADDRESS (If different than above): VALID UNTIL: _________________________________________
________________________________________________________________________________________________________________________
_______________________________________________________________________________ COUNTRY: _____________________________
PHONE: ________________________ FAX: _______________________________ EMAIL: ________________________________________
DATE OF BIRTH: (mm/dd/yy): ________/________/________
AGE: _________
CITIZENSHIP: ___________________________
2) MARITAL STATUS:
_____SINGLE
_____ENGAGED
_____DIVORCED
_____SEPARATED
_____REMARRIED
_____MARRIED
_____WIDOWED
CHILDREN? _________ (If yes, please indicate names and ages) __________________________________________________________
Also, are you involved in any other long-term relationship that we should be aware of (i.e. Boyfriend/Girlfriend)?
________________________________________________________________________________________________________________________
3) HOW DID YOU HEAR ABOUT THIS BASE? ________________________________________________________________________
________________________________________________________________________________________________________________________
What reasons most influenced your decision to apply for the DTS in Maui?
_____ LOCATION
_____ TARGETED OUTREACH LOCATIONS
_____ ESCAPE A BAD HOME ENVIRONMENT
_____ SURFERS DTS
_____ FEEL CALLED TO MISSIONS
_____ OTHER: __________________________________
Please choose which of the above apply to you and explain: _______________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
Do you have any friends that are also applying for the same DTS? _________________________________________________________
4) CHURCH INFORMATION:
NAME: ___________________________________________________
MAILING ADDRESS: (Street/PO Box #, City, State/Province, Zip/Postal Code,Country) _____________________________________
________________________________________________________________________________________________________________________
PASTOR’S NAME (Title & Name): _______________________________________________________________________________________
5) EDUCATION & SKILLS:
I HAVE COMPLETED:
______HIGH/SECONDARY SCHOOL
______EQUIVALENT OF HIGH/SECONDARY SCHOOL
A) HIGH SCHOOL/SECONDARY/COLLEGE/UNIVERSITY/SEMINARY ATTENDED:
NAME OF ESTABLISHMENT
DATES ATTENDED
GRADUATION DATE & MAJOR
___________________________
___________________________
__________________ ______________________________
B) PREVIOUS YWAM PROGRAMS/SCHOOLS ATTENDED:
SCHOOL/PROGRAM
LOCATION
OUTREACH DESTINATION
DATES ATTENDED
________________ __________________________ __________________
___________________
________________ C) OCCUPATIONS/JOB EXPERIENCE:
OCCUPATION/TITLE:
__________________________ __________________
________________________________ _________________
________________________________ _________________
__________________________
D) PERSONAL SKILLS:
PROFESSIONAL LICENSES/QUALIFICATIONS: ___________________________________________________________________
___________________
__________________ LOCATION
______________________________
LENGTH OF EMPLOYMENT
__________________________
MUSICAL/OTHER TALENTS: ____________________________________________________________________________________
LANGUAGES: __________________________________________________________________________________________________
(If English is your second language, you will need to fill out an “English Language Questionnaire”)
6) REFERENCE LIST:
PASTOR/SPIRITUAL LEADER:
Mr/Mrs/Miss: __________________________________________________________________________________________________________
Mailing Address: (Street/Box #, City, Prov/State, Postal Code/Zip, Country) _______________________________________________
________________________________________________________________________________________________________________________
Phone: ____________________________ Fax: _________________________________ Email: ______________________________________
EMPLOYER/TEACHER/YWAM LEADER:
Mr/Mrs/Miss: __________________________________________________________________________________________________________
Mailing Address: (Street/Box #, City, Prov/State, Postal Code/Zip, Country) _______________________________________________
________________________________________________________________________________________________________________________
Phone: ____________________________ Fax: _________________________________ Email: ______________________________________
FRIEND:
Mr/Mrs/Miss: __________________________________________________________________________________________________________
Mailing Address: (Street/Box #, City, Prov/State, Postal Code/Zip, Country) _______________________________________________
________________________________________________________________________________________________________________________
Phone: ____________________________ Fax: _________________________________ Email: ______________________________________
Health Form
BASIC INFO: STARTING DATE OF DTS APPLYING FOR: ____________________________
NAME OF APPLICANT: _________________________________________________________________________________________________
MAILING ADDRESS (Street/Box #, City, State/Prov, Zip/Postal Code): ____________________________________________________
___________________________________________________________________ COUNTRY: _________________________________________
PHONE: ______________________________ FAX: _______________________________ EMAIL: ___________________________________
DATE OF BIRTH (mm/dd/yy): _____/_____/_____ SOCIAL SECURITY #: ___________________________________
PERSON TO CONTACT IN CASE OF EMERGENCY:
NAME OF CONTACT: ___________________________________________________________________________________________________
MAILING ADDRESS (Street/Box #, City, State/Prov, Zip/Postal Code): _____________________________________________________
___________________________________________________________________ COUNTRY: _________________________________________
PHONE: ______________________________ FAX: _______________________________ EMAIL: ___________________________________
MEDICAL INSURANCE:
NAME OF INSURER: ______________________________________ MEDICAL INSURANCE #: ____________________________________
PERSONAL HISTORY:
HEIGHT: _________________ WEIGHT: __________________ BLOOD TYPE: ____________________
YOU WOULD RATE YOUR HEALTH CONDITION AS: _______EXCELLENT
_______GOOD
_______FAIR
_______POOR
HAVE YOU EVER BEEN INVOLVED, WITH THE FOLLOWING? IF YES - EXPLAIN, AND LIST MOST RECENT DATES OF USE.
ALCOHOL: _____________________________________________________________________________________________________________
SMOKING: _____________________________________________________________________________________________________________
ILLEGAL DRUGS: ______________________________________________________________________________________________________
HAVE YOU EVER HAD ANY OF THE FOLLOWING COMMUNICABLE DISEASES?
YES
NO
YES
NO
YES
NO
CHICKENPOX
MUMPS
TUBERCULOSIS
MEASLES (RUBELLA)
PERTUSSIS
OTHER (SPECIFY)
MEASLES (RUBEOLA)
SCARLET FEVER
HAVE ANY OF YOUR RELATIVES EVER HAD ANY OF THE FOLLOWING?
YES
NO
YES
NO
YES
NO
TUBERCULOSIS
HEART DISEASE
STOMACH DISEASE
DIABETES
HYPERTENSION
EPILEPSY
KIDNEY DISEASE
ARTHRITIS
CANCER
PLEASE ANSWER ALL QUESTIONS. COMMENT ON ALL “YES” ANSWERS IN THE SPACE BELOW, OR ON A SEPARATE SHEET OF PAPER. HAVE YOU EVER HAD ANY OF THE FOLLOWING?:
YES
NO
YES
NO
YES
NO
Skin Conditions
Heart Trouble
Jaundice
Eye Trouble
High Blood Pressure
Hepatitis
Ear Trouble
Low Blood Pressure
Intestinal Trouble
Head Injury
Arthritis
Recurrent Diarrhea
Recurrent Headaches
Back Problems
Diabetes
Epilepsy
Dislocation of Joint
Kidney Disease
Fainting Spells
Tumor/Cancer
Anemia
Mental Disorders
Stomach Ulcer
Venereal Disease
Nervous Disorders
Gall Bladder Problems
A.I.D.S.
Paralysis
Surgery
FEMALES ONLY
Insomnia
Appendectomy
Irregular Periods
Shortness of Breath
Tonsillectomy
Severe Cramps
Hay Fever/Asthma
Hernia Repair
Excessive Flow
Allergies (specify)
Other (specify)
Are you pregnant?
IF YES PLEASE EXPLAIN: ____________________________________________________________________________________________
IMMUNIZATIONS (Basic Booster and most recent):
YEAR
YEAR
YEAR
YEAR
Diphtheria
Tetanus
YEAR
YEAR
ARE YOU CURRENTLY UNDER A DOCTOR OR
HEALTH CARE PROFESSIONAL’S CARE FOR
ANY CONDITION?
Pertussis
______YES ______NO
Polio
IF YES, PLEASE EXPLAIN: _______________________
Rubella
__________________________________________________
Rubeola
PLEASE LIST ANY MEDICATIONS YOU ARE CURRENTLY TAKING:
Mumps
Hep A
__________________________________________________
Hep B
__________________________________________________
Tetanus
Typhoid
*A PHYSICIAN MUST FILL OUT THIS PORTION *
(Absolutely required by the state of Hawaii for entrance - Tuberculosis Control)
Only one of the following are required:
1)Chest X-Ray:
Date: _____/_____/_____ Result: _________________________ Exam Facility: _________________________________
2)Skin Test:
Date: _____/_____/_____ Result: _________________________ Exam Facility: _________________________________
Physician’s Name: _________________________________________________________________________________________
Mailing Address: ___________________________________________________________________________________________
Phone: ________________________ Fax: ____________________________ Email: ___________________________________
CONSENT FOR TREATMENT
In case of emergency, I/we hereby agree to the performance of such treatment including anesthesia and surgery as the
attending doctor or physician may deem necessary.
___________________________________
(Applicant’s Name Printed) ___________________________________
(Parent or Guardian of those under 18)
_____________________________
(Applicant’s Signature) ___________________________________
(Date)
_____________________________
(Parent or Guardian Signature)
___________________________________
(Date)
Financial Form
START DATE OF DTS APPLYING FOR: _________________
NAME OF APPLICANT: ______________________________________________________________________________________________
DO YOU HAVE THE COMPLETE SCHOOL FEES?: ______ YES ______ NO
IF YES, WHAT IS YOUR SOURCE?: ____________________________________________________________________________________
________________________________________________________________________________________________________________________
IF NO, HOW DO YOU PLAN ON PAYING FOR YOUR SCHOOL? PLEASE EXPLAIN?: ____________________________________
________________________________________________________________________________________________________________________
DO YOU HAVE ANY OUTSTANDING DEBTS?: ______ YES ______ NO
IF YES, PLEASE EXPLAIN: ___________________________________________________________________________________________
________________________________________________________________________________________________________________________
I/we understand that payment of the required school tuition must be paid in U.S. CURRENCY
prior to or upon my arrival, unless otherwise approved in writing by the school director before my departure for Hawaii. Further, I agree to meet in a timely manner, prior to the completion of the school,
all personal expenses incurred during my involvement with Youth With A Mission. I will abide by the
Spirit, rules, and schedule of the school.
_________________________________________ Date: ______/______/______
_________________________________________ Date: ______/______/______
(PARENT OR LEGAL GUARDIAN IF APPLICANT
IS UNDER 18 YEARS OF AGE)
(APPLICANT’S SIGNATURE) RELATIONSHIP TO APPLICANT: _______________________________
(MM/DD/YY)
(MM/DD/YY)
Waiver of Liability and Release
STARTING DATE OF DTS APPLYING FOR: _______________________
I, the undersigned, individually hereby release YOUTH WITH A MISSION (herein after YWAM),
it’s staff, agents, employees, and representatives, from all claims, causes of action or lawsuits relating
to or resulting from activities or events involving YWAM. I hereby acknowledge and agree that I am
personally aware of all risks associated with or related to missions work, sporting events, training,
traveling, interaction with foreign people and nations and all activities which are part of the YWAM
program. I agree to assume all risk of injury or loss that may occur or be related to in any other manner to YWAM or the activities I may engage in while with YWAM.
This Release shall apply to all claims for physical and/or mental injury, attorney’s fees, costs
and expenses of litigation, claims for loss of consortium, medical expenses, loss of earning, punitive
damages, and all other claims whatsoever, which may result from or be in any manner related to
YWAM.
I further promise to agree to indemnify, defend, and forever hold harmless YWAM, it’s staff,
agents, employees, and representatives against all claims, actions, cross-claims, or third-party claims
arising from or ins any manner related to YWAM - whether such actions are brought by third-party
claims arising from or in any manner related to YWAM or whether such actions are brought by third
parties or anyone acting on behalf of myself.
In the event that YWAM files any action to enforce the provisions, releases and covenants of
this agreement, YWAM shall be entitled to all reasonable attorney’s fee and costs of such enforcement
proceeding.
BY SIGNING THIS RELEASE, IN UNDERSTAND THAT I AM RELEASING ALL
CLAIMS FOR INJURY OR DAMAGE.
_________________________________________
Date: ______/______/______
_________________________________________
Date: ______/______/______
(PARENT OR LEGAL GUARDIAN IF APPLICANT IS UNDER 18 YEARS OF AGE) (APPLICANT’S SIGNATURE)
(MM/DD/YY)
(MM/DD/YY)
Personal History
PRAYERFULLY ANSWER THE FOLLOWING QUESTIONS IN THE SPACE PROVIDED.
PLEASE TYPE OR PRINT IN ENGLISH.
1) DESCRIBE YOUR CONVERSION EXPERIENCE: ____________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
2) DESCRIBE YOUR PRESENT WALK WITH GOD: ____________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
WHAT ARE THREE AREAS YOU DESIRE TO GROW IN OR IMPROVE ON DURING THIS TIME?: __________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
DO YOU FEEL GOD HAD GIVEN YOU, OR IS LEADING YOU INTO, A PARTICULAR AREA OF MINISTRY?: _________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
DESCRIBE YOUR PRESENT RELATIONSHIP WITH YOUR LOCAL CHURCH: ____________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
HOW WOULD YOU DESCRIBE YOUR RELATIONSHIP WITH YOUR FAMILY? HOW DO THEY FEEL ABOUT YOUR
INVOLVEMENT IN OUR UPCOMING DTS?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Please note: Answering “YES” to the following questions will not automatically exclude you from the DTS.
We are more interested in how you have grown from these experiences while prayerfully considering your
application.
7) HAVE YOU EVER BEEN INVOLVED IN: RELIGIOUS CULTS? USE OF DRUGS? ALCOHOLISM? HOMOSEXUALITY? OCCULTISM? IF SO PLEASE EXPLAIN:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
8) HAVE YOU EVER BEEN CAUTIONED, CHARGED OR CONVICTED OF A CRIMINAL OFFENSE IN THIS COUNTRY
OR ABROAD, OR HAVE ANY CASES PENDING? IF SO, PLEASE EXPLAIN:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
9) PLEASE LIST ANYTHING WE SHOULD KNOW ABOUT YOU AND YOUR SITUATION: __________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Outreach Privilege
Acknowledgement and Agreement
Document
I agree to adhere to and abide by all the guidelines and rules of YWAM Maui DTS
program. This agreement applies to my time during the lecture phase, in Maui, and during
outreach, including stay in other countries.
I understand that the outreach portion of the DTS program is a privilege and not
guaranteed. If the leadership of the DTS have prayerfully deemed that I am not ready or
suitable to do missions work in a given outreach location, I agree to not go with the rest of the
team on outreach representing YWAM. I will trust the DTS leadership’s decision and adhere
to the decision.
I understand that all the money paid toward the outreach will be refunded, minus
money already spent on preparation of the outreach at the time of the DTS leadership’s
decision not to send me on outreach. Such non-refundable costs include visa application and
shipping fees, pre-outreach costs (including costs associated with the Acts program), airline
ticket cancellation fees, and non-refundable airline ticket costs.
_________________________________________
_________________________________________
_________________________________________
(PARENT OR LEGAL GUARDIAN IF APPLICANT IS UNDER 18 YEARS OF AGE) (NAME PRINTED)
(APPLICANT’S SIGNATURE)
Date: ______/______/______
(MM/DD/YY)
Passport/Visa Information
STARTING DATE OF DTS APPLYING FOR: ____________________
PLEASE NOTE: YOU MUST HAVE A VALID PASSPORT PRIOR TO THE BEGINNING OF THE SCHOOL.
NAME AS LISTED ON PASSPORT: _________________________________________________________________
PLACE OF BIRTH: ________________________________________________________________________________
(CITY)
(COUNTRY)
CITIZENSHIP/NATIONALITY: _____________________________________________________________________
PASSPORT NUMBER: _____________________________________________________________________________
PLACE OF ISSUE: ________________________________________________________________________________
(CITY)
(COUNTRY)
DATE OF ISSUE: ________/________/________
(MM/DD/YY)
DATE OF EXPIRY: ________/________/________
(MM/DD/YY)
Please return to:
YWAM Maui - Registrar
PO Box 790237
Paia, Maui - Hawaii
96779
USA
Surf Questionnaire
(Surfers for Missions International Applicants ONLY)
In order to be a part of Surfers For Missions International (SFMI) DTS Team, we need to assess your surf
skills. This will help determine which school or team you will be placed, and it does not influence your
acceptance to the DTS program. Certain schools are geared toward novice surfers and some schools are for more
experienced surfers. We ask that you are honest in your answers. Please note that if the information you
provide here does not match your skills in the water, we may transfer you from the surf team to the non-surf
team, even after the start of the school.
Do you surf, windsurf, or bodyboard?: _______________________________________________________________________
Do you longboard or short-board?: __________________________________________________________________________
How many years have you been surfing?: ____________________________________________________________________
How often do you surf a week during surf season?: ___________________________________________________________
When is your surf season?: _________________________________________________________________________________
Where is your home break?: ________________________________________________________________________________
What shape and size board do you mainly use?: ______________________________________________________________
Have you traveled to a surf destination? If so, where and how big were the waves that you surfed in?:
____________________________________________________________________________________________________________
Do you consider yourself to be: _____Beginner _____Average _____Good _____Advanced
What size waves do you feel comfortable up to?:
_____Chest HIgh _____Head High _____Head and a half _____Double Overhead
Have you surfed in a contest? If so, which one?
____________________________________________________________________________________________________________
Are you well aware of the rules and etiquette of surfing?: _____________________________________________________
English Language Questionnaire
ALL STUDENTS WHO DO NOT HAVE ENGLISH AS THEIR FIRST LANGUAGE MUST COMPLETE THIS
FORM AND RETURN IT TO OUR OFFICE BEFORE THEIR APPLICATION CAN BE CONSIDERED.
NAME: __________________________________________________________________________________________
PERMANENT ADDRESS: _______________________________________________________________________
________________________________________________________ COUNTRY: _____________________________
(Street/Box #, City, State/Province, Zip/Postal Code, Country)
1. How long have you studied English? __________ years
2. Have you ever had a native English speaker as a teacher? _____Yes _____No
If yes, when?: _______________________________________________________________________
For what class?: _____________________________________________________________________
For how long?: ______________________________________________________________________
4. Have you ever lived or worked in an English-speaking country? _____Yes _____No
If yes, where?: ______________________________________________________________________
For how long?: ______________________________________________________________________
5. Describe the help you would need to complete written and reading assignments and to
understand lectures in an English-speaking classroom.
3. Have you ever studied in an English-speaking country? _____Yes _____No
If yes, where?: ______________________________________________________________________
For how long?: ______________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Confidential Reference Form
Pastor/Spiritual Leader
Name of applicant:_________________________________________________ Date of School Applying For: ______________________
Street/Box #: __________________________________ City: _______________________________ State/Province: __________________
Zip/Postal Code: _________________ Country: _____________________ Phone: ____________________ Email: ___________________
*I/We the above mentioned applicant, waive any right I have to read or obtain copies of this recommendation, knowing that
this is not required as a condition for admission.
APPLICANT’S SIGNATURE: _______________________________________________ DATE: ____________________________________
The applicant named above has applied for admission to one of Youth With A Mission’s ministries. YWAM is an International
movement of Christians from many denominations dedicated to presenting Jesus Christ to this generation, to mobilizing as
many as possible to help in this task and to the training and equipping of believers for their part in fulfilling the Great
Commission. In order to adequately evaluate the applicant for admission, we would appreciate your supplying the
information requested on this form. Your statement will help us to effectively meet the needs of the applicant should he/she
be accepted into the program applied for. It is therefore not in the applicant’s best interest to give an unrealistically positive
view of them. An honest, realistic appraisal of the challenges they will face will help, rather than hinder their application. If
you would prefer to give your opinions by telephone, please feel free to do so.
1. How long have you known the applicant? _____________________________________________________________________________
2. On a scale of 1 to 10, how well do you feel you know the applicant? (1 being very little, 10 being intimately)
Circle one:
1
1
3
4
5
6
7
8
9
10
3. How long has the applicant attended your church? ____________________________________________________________________
4. In your association with the applicant - what has been the level of commitment you have seen exemplified?
_____Faithful
_____Inconsistent
_____Other
5. In your opinion, in which of the following areas of ministry is the applicant gifted?
Communication
Preaching
Drama
Secretarial work
One-on-one
Music
Worship
Discipleship
Pastoring
Counseling
Prayer
Carpentry
Children’s work
Nurse
Doctor
Youth Work
Teaching
Art
Plumbing
Servant hearted
Evangelism
Hospitality
Encourager
Administration
6. In which of the above areas or any other has the applicant participated in since attending your church?
________________________________________________________________________________________________________________________
7. Does the applicant now or have they ever had any involvement with: _____smoking _____alcohol _____drugs
If yes - please explain: __________________________________________________________________________________________________
8. Please circle any words or descriptions which pertain to the applicant:
Impatient
Intolerant
Domineering
Critical of Others
Offended
Discouraged
Anxious
Nervous or tense
Prejudiced towards groups
Prejudiced towards races
Addictive behavior
Unable to cope with stress
Argumentative
Easily Embarrassed
Frequently worried
Given to moods
Prejudiced towards nationalities
Erratic in attitudes
If you have noticed any of these, or similar limitations in the applicant’s life, please elaborate on a separate sheet of paper.
9. Check any of the following which you feel are motivating the applicant to attend a YWAM school.
_____ Christian Service
_____ Desire to help others
_____ Receive help, ministry & discipleship
_____ Travel
_____ Desire to spread the Gospel
_____ Adventure
_____ Escape an unpleasant home situation _____ Other: _______________________
10. Has the applicant proven on any occasion to be unreliable, dishonest, or of questionable character?
_____Yes
_____No
If yes, please explain: ___________________________________________________
________________________________________________________________________________________________________________________
11. As far as you know, has the applicant ever been arrested for any offenses?
12. Does the applicant respond well to authority? _____Yes
_____Yes
_____No
_____No
If no, please explain: ___________________________________________________________________________________________
13. In your consideration, which of the following would best describe the applicant’s Christian experience?
_____Mature
_____Contagious
_____Genuine & growing
_____Over-emotional
_____Superficial
14. Is your congregation standing behind the applicant with total enthusiasm? ____________________________________________
Would you like more information on YWAM? _____________________________________________________________
15. Please comment briefly on the applicant’s family background (if known): ______________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
16. Have we overlooked anything, which you consider relevant to this application? (Use separate sheet of paper if necessary)
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
17. What is your overall evaluation of the applicant’s promise as a YWAM student?
_____Definitely unsuited
_____Average prospect
_____At this time, he/she is definitely unsuited
_____Above average prospect
_____Good prospect, but I have some reservations
_____Unusually exceptional prospect
If you have any reservations, your comments would be helpful: (Use separate sheet of paper if necessary)
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
I declare that the contents of this reference are correct to the best of my knowledge.
NAME: ___________________________________________________ RELATION: ________________________________________________
STREET/BOX #: ___________________________________________________________ CITY: _____________________________________
STATE/PROVINCE: __________________ ZIP/POSTAL CODE: _________________________ COUNTRY: __________________________
PHONE: ___________________________ FAX: _____________________________ EMAIL: ________________________________________
SIGNATURE: _________________________________________________________ DATE: _________________________________________
Please send this completed form in a sealed envelope to:
Registrar - YWAM Maui
PO Box 790237
Paia, Maui - HI
96779 - USA
Toll Free: 1-866-579-8402
Fax: 808-575-9476
Confidential Reference Form
Employer/Teacher/YWAM Leader
Name of applicant:_________________________________________________ Date of School Applying For: _____________________
Street/Box #: __________________________________ City: _______________________________ State/Province: _________________
Zip/Postal Code: _________________ Country: _____________________ Phone: ____________________ Email: __________________
*I/We the above mentioned applicant, waive any right I have to read or obtain copies of this recommendation, knowing
that this is not required as a condition for admission.
APPLICANT’S SIGNATURE: _______________________________________________ DATE: ___________________________________
The applicant named above has applied for admission to one of Youth With A Mission’s ministries. YWAM is an International
movement of Christians from many denominations dedicated to presenting Jesus Christ to this generation, to mobilizing as
many as possible to help in this task and to the training and equipping of believers for their part in fulfilling the Great Commission. In order to adequately evaluate the applicant for admission, we would appreciate your supplying the information
requested on this form. Your statement will help us to effectively meet the needs of the applicant should he/she be accepted
into the program applied for. It is therefore not in the applicant’s best interest to give an unrealistically positive view of
them. An honest, realistic appraisal of the challenges they will face will help, rather than hinder their application. If you
would prefer to give your opinions by telephone, please feel free to do so.
1. How long have you known the applicant? _____________________________________________________________________________
In what capacity? ______________________________________________________________________________________________
2. On a scale of 1 to 10, how well do you feel you know the applicant? (1 being very little, 10 being intimately)
Circle one:
1
1
3
4
5
6
7
8
9
10
3. Please describe in your own words how you would rate the applicant in the following areas:
Health __________________________________ Mental Ability ________________________________________
Initiative
__________________________________ Social Adaptability
________________________________________
Reliability
__________________________________ Ability to cope with stress ______________________________________
Personal appearance _____________________________
Cooperation
________________________________________
Concern for others _______________________________
Self discipline
________________________________________
Leadership
Christian character
________________________________________
Emotional stability _______________________________ Temperament ________________________________________
Ability to follow __________________________________ Punctuality
________________________________________
Flexibility
Perseverance
________________________________________
__________________________________ __________________________________ 4. Does the applicant now or have they ever had any involvement with: _____smoking _____alcohol _____drugs
If yes - please explain: __________________________________________________________________________________________________
5. Please circle any words or descriptions which pertain to the applicant:
Impatient
Intolerant
Domineering
Critical of Others
Offended
Discouraged
Anxious
Nervous or tense
Prejudiced towards groups
Prejudiced towards races
Addictive behavior
Unable to cope with stress
Argumentative
Easily Embarrassed
Frequently worried
Given to moods
Prejudiced towards nationalities
Erratic in attitudes
If you have noticed any of these, or similar limitations in the applicant’s life, please elaborate on a separate sheet of paper.
6. As far as you know, has the applicant ever been arrested for any offenses? _____ Yes _____ No
7. Evaluation of Emotional Ability: Due to the cultural & environmental context of the school, adjustments have to be made
as to diet, social customs, climate change, living arrangements, etc. Keeping in mind the challenge of these unusual demands,
please rate the applicant as to his/her maturity & stability: (please check one)
_____ Outstandingly mature. Has proven his/her ability to operate under stress and pressure
_____ More mature and emotionally stable than average
_____ Possesses adequate emotional stability and maturity
_____ Doubtful. Experience has shown that the applicant might not be able to endure stress
_____ Applicant has frequently demonstrated signs of inability to cope with stress such as rage or withdrawal,
is erratic in attitude and action or has demonstrated emotional instability in other ways.
8. How does the applicant usually react in trying situations? (please check one)
_____ Withdrawals _____ Gets discouraged _____ Gets angry
_____ Meets constructively _____ Accepts patiently _____ Other: ___________________________________
7. Has the applicant proven on any occasion to be unreliable, dishonest, or of questionable character?
_____Yes
_____No
If yes, please explain: ___________________________________________________
________________________________________________________________________________________________________________________
8. Is the applicant punctual? _____ Yes _____ No
9. Is the applicant dependable and trustworthy with the responsibility given to him/her?
_____ Yes _____ No
If no, please explain: _______________________________________________
10. Have we overlooked anything, which you consider relevant to this application? (Use separate sheet of paper if necessary)
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
11. What is your overall evaluation of the applicant’s promise as a YWAM student?
_____Definitely unsuited
_____Average prospect
_____At this time, he/she is definitely unsuited
_____Above average prospect
_____Good prospect, but I have some reservations
_____Unusually exceptional prospect
If you have any reservations, your comments would be helpful: (Use separate sheet of paper if necessary)
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
I declare that the contents of this reference are correct to the best of my knowledge.
NAME: ___________________________________________________ RELATION: _______________________________________________
STREET/BOX #: ___________________________________________________________ CITY: ____________________________________
STATE/PROVINCE: __________________ ZIP/POSTAL CODE: _________________________ COUNTRY: _________________________
PHONE: ___________________________ FAX: _____________________________ EMAIL: _______________________________________
SIGNATURE: _________________________________________________________ DATE: ________________________________________
Please send this completed form in a sealed envelope to:
Registrar - YWAM Maui
PO Box 790237
Paia, Maui - HI
96779 - USA
Toll Free: 1-866-579-8402
Fax: 808-575-9476
Confidential Reference Form
Friend
Name of applicant:_________________________________________________ Date of School Applying For: _____________________
Street/Box #: __________________________________ City: _______________________________ State/Province: _________________
Zip/Postal Code: _________________ Country: _____________________ Phone: ____________________ Email: __________________
*I/We the above mentioned applicant, waive any right I have to read or obtain copies of this recommendation, knowing
that this is not required as a condition for admission.
APPLICANT’S SIGNATURE: _______________________________________________ DATE: ___________________________________
The applicant named above has applied for admission to one of Youth With A Mission’s ministries. YWAM is an International
movement of Christians from many denominations dedicated to presenting Jesus Christ to this generation, to mobilizing as
many as possible to help in this task and to the training and equipping of believers for their part in fulfilling the Great
Commission. In order to adequately evaluate the applicant for admission, we would appreciate your supplying the
information requested on this form. Your statement will help us to effectively meet the needs of the applicant should he/she
be accepted into the program applied for. It is therefore not in the applicant’s best interest to give an unrealistically positive
view of them. An honest, realistic appraisal of the challenges they will face will help, rather than hinder their application. If
you would prefer to give your opinions by telephone, please feel free to do so.
1. How long have you known the applicant? _____________________________________________________________________________
2. On a scale of 1 to 10, how well do you feel you know the applicant? (1 being very little, 10 being intimately)
Circle one:
1
1
3
4
5
6
7
8
9
10
3. In your opinion, in which of the following areas of ministry is the applicant gifted?
Communication
Preaching
Drama
Secretarial work
One-on-one
Music
Worship
Discipleship
Pastoring
Counseling
Prayer
Carpentry
Children’s work
Nurse
Doctor
Youth Work
Teaching
Art
Plumbing
Servant hearted
Evangelism
Hospitality
Encourager
Administration
According to your observations in which of the above-mentioned areas would you consider your friend to be especially gifted?
________________________________________________________________________________________________________________________
3. Please describe in your own words how you would rate the applicant in the following areas:
Health __________________________________ Mental Ability ________________________________________
Initiative
__________________________________ Social Adaptability
________________________________________
Reliability
__________________________________ Ability to cope with stress ______________________________________
Personal appearance _____________________________
Cooperation
________________________________________
Concern for others _______________________________
Self discipline
________________________________________
Leadership
Christian character
________________________________________
Emotional stability _______________________________ Temperament ________________________________________
Ability to follow __________________________________ Punctuality
________________________________________
Flexibility
Perseverance
________________________________________
__________________________________ __________________________________ 4. Does the applicant now or have they ever had any involvement with: _____smoking _____alcohol _____drugs
If yes - please explain: __________________________________________________________________________________________
6. As far as you know, has the applicant ever been arrested for any offenses? _____ Yes _____ No
7. Please circle any words or descriptions which pertain to the applicant:
Impatient
Intolerant
Domineering
Critical of Others
Offended
Discouraged
Anxious
Nervous or tense
Prejudiced towards groups
Prejudiced towards races
Addictive behavior
Unable to cope with stress
Argumentative
Easily Embarrassed
Frequently worried
Given to moods
Prejudiced towards nationalities
Erratic in attitudes
If you have noticed any of these, or similar limitations in the applicant’s life, please elaborate on a separate sheet of paper.
8.
Is the applicant faithful in church attendance?
________ Yes ________ No
Is the applicant active in church activities/programs?
________ Yes _______ No
9. Has the applicant proven on any occasion to be unreliable, dishonest, or of questionable character?
_____Yes
_____No
If yes, please explain: ___________________________________________________
________________________________________________________________________________________________________________________
10. Does the applicant respond well to authority? _____Yes
_____No
If no, please explain: ___________________________________________________________________________________________
11. In your consideration, which of the following would best describe the applicant’s Christian experience?
_____Mature
_____Contagious
_____Genuine & growing
_____Over-emotional
_____Superficial
12. Please comment briefly on the applicant’s family background (if known): ______________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
13. Have we overlooked anything, which you consider relevant to this application? (Use separate sheet of paper if necessary)
________________________________________________________________________________________________________________________
14. What is your overall evaluation of the applicant’s promise as a YWAM student?
_____Definitely unsuited
_____Average prospect
_____At this time, he/she is definitely unsuited
_____Above average prospect
_____Good prospect, but I have some reservations
_____Unusually exceptional prospect
I declare that the contents of this reference are correct to the best of my knowledge.
NAME: ___________________________________________________ RELATION: _______________________________________________
STREET/BOX #: ___________________________________________________________ CITY: ____________________________________
STATE/PROVINCE: __________________ ZIP/POSTAL CODE: _________________________ COUNTRY: _________________________
PHONE: ___________________________ FAX: _____________________________ EMAIL: _______________________________________
SIGNATURE: _________________________________________________________ DATE: ________________________________________
Please send this completed form in a sealed envelope to:
Registrar - YWAM Maui
PO Box 790237
Paia, Maui - HI
96779 - USA
Toll Free: 1-866-579-8402
Fax: 808-575-9476