ࡱ> \^[q` x7bjbjqPqP 4V::x/8 8 8 8 4l Dd* p,!,!,!,!,!,!,!)))))))$+h-z *',!,!'' *,!,!*S)S)S)'F,!,!)S)')S)S)S),! DX58 'jS))4*0d*S)-C(-S)-S),!"&S)#$,!,!,! * *I) ,!,!,!d*'''' YOUTH WITH A MISSION-LIBERIA P.O.BOX 2046 MONROVIA, LIBERIA, WEST AFRICA Email:  HYPERLINK "mailto:ywamliberia@yahoo.com" ywamliberia@yahoo.com,  HYPERLINK "http://www.ywamlib.org" www.ywamlib.org , cell #: 231 6 605099 Discipleship Training School APPLICATION FORM Personal information Applying for: ___________DTS. Non refundable Registration Fee______ Mr. / Mrs. / Miss. ___________________________ Email: _______________ Sex______ Current Address___________________________________ Phone__________________ Street/ P.O. Box City State/Province Zip Code Country Age: ____ Birthday: Month_____ Day_____ Year______ Birthplace_______________________________________ Citizenship: _______________________________________ Social Security #____________________________ Marital Status: Single____ Married______ Engaged_____ Divorced_____ Separated_____ Remarried_____ Widowed___ Spouses Name___________________________ Address if not the same as above____ ________________________________________________________________________ Name of any children accompanying you: Name Birth date Sex School/Grade ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Church Information Church Name _______________________________ Pastors name _________________ Church Address___________________________________________________________ Denomination_______________________ Pastors Phone # _______________________ How long have you attended the church? ____________ How long have you been a born again Christian? _____________ In Case of Emergency Contact: Full name__________________________________ Relationship_______________ Address___________________________________ Country_________________ Phone______________ e-mail__________________ Testimony: On a separate sheet of paper please tell us about your salvation experience and how you have grown in the Lord since that time. Educational Information: (Highest Level Completed) Degree: __________________ School name: ___________________________________ Location________________________ Date of Graduation:__________________ I have not completed High School__________ List pervious YWAM or Mission exposure and experience: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ In what area of our mission are you willing and interested in serving? _______________ ________________________________________________________________________________________________________________________________________________ If there are no openings in your area are you willing to serve in other areas? Yes__ No__ Other background information Previous Occupation (if any): _______________________________________________ ________________________________________________________________________ What languages do you speak? ______________________________________________ Occupational / Trade Skills: ________________________________________________ Ministry Skills, Talents, and Abilities: ________________________________________ _______________________________________________________________________ Health/ Medical Information Do you have any allergies? Yes__ No___ if yes (specify) _________________________ ________________________________________________________________________ Do you have any special dietary needs? ______________________________________ Are you under Doctors care or have any medical conditions? _____________________ Are you taking any medications? (Specify)_____________________________________ Do you have any handicaps or special needs? __No ___Yes (specify) ________________ I certify that the information submitted is true, accurate and complete. Applicants Signature ______________________________ Date __________________ Release of Liability: I do hereby release Youth With A Mission Liberia, its staff, agents and volunteers assistants from all liability whatsoever arising out of any injury, damage, or loss, which may be sustained by, said person (s) during the course of involvement with Youth With A Mission. Applicants Signature ________________________________ Date _________________ Acknowledgement of Financial Responsibility: I understand that I have a financial responsibility to YWAM Liberia. This responsibility can be fulfilled through paying the necessary fees and through community services that help fulfill the needs or mission of YWAM Liberia. Fees in combination with community service may be applied as determined by the leadership of the School depending upon the need. I ____________________ certify that all the information in this application is complete and accurate. I will endeavor to pay my school fees as best I can and in a timely manner. I also commit myself to other activities that will help meet my financial responsibility to the school and also in regard to my personal expenses. If I am accepted in the YWAM training program I will also abide by the spirit, rules and schedules of the school. The school will be divided into two phases; three months Lecture and three months Outreach. Both have separate fees. Do you have your school fees ready? ______ If no, how much do you have at this time? $__________ Do you have any outstanding debt?____ Please explain how you expect to pay your fees? _______________________________________________________________________ _______________________________________________________________________ Applicants Signature _________________________________ Date ________________ Consent for Treatment: In case of emergency, I hereby agree to the performance of such treatment, including anesthesia and surgery, as the attending the doctor or physician may deem necessary. I also accept full responsibility for expenses related to medical care. Applicants Signature _____________________________ Date _________________ Medical Insurance Insurance Company___________________________________ Phone_____________ Policy Number_________________________ Countries in which insured___________ ______________________________________________________________________ Send all completed forms to the following address: YOUTH WITH A MISSION LIBERIA P.O.BOX 2046 MONROVIA, LIBERIA, WEST AFRICA Email:  HYPERLINK "mailto:ywamliberia@yahoo.com" ywamliberia@yahoo.com,  HYPERLINK "http://www.ywamlib.org" www.ywamlib.org , cell #: 231 6 605099 YOUTH WITH A MISSION LIBERIA P.O.BOX 2046 MONROVIA, LIBERIA, WEST AFRICA Email:  HYPERLINK "mailto:ywamliberia@yahoo.com" ywamliberia@yahoo.com,  HYPERLINK "http://www.ywamlib.org" www.ywamlib.org , cell #: 231 6 605099 CONFIDENTIAL REFERENCE FORM Please check appropriate reference Pastor/Spiritual Leader: ___ Employer/ Teacher___ Friend ______ To the applicant: Please complete the information below and provide three references from above listing and return to the above address: YWAM Liberia Name of applicant: ____________________________ Phone #___________________ Address: _______________________ City______________ State _________________ Country_______________________Zip Code________________ Applying for: DTS Date ___________________ I the above name applicant waive any right I have to read or obtain any copies of this recommendation knowing that this waiver is not required as a condition for admission. Applicants signature ________________________ Date ________________________ The above applicant has applied for admission to Youth With A Mission- Discipleship Training School. Serious consideration will be given to your comments. Therefore we ask that you complete this form carefully. Your early response will be most appreciated, as the applicants file cannot be considered until all forms have been received by this office. Thank you for taking time to help us in this way. We sincerely appreciate your consideration. Please check the following and comment when necessary: Your relationship to the applicant _______________ How long have you known the applicant? __________________ How well do you know the applicant? Very well__ Well___ Casually____ In what capacity is the applicant active in church work? __________________________ _______________________________________________________________________ Does she or he display high moral standards? (Explain) __________________________ _______________________________________________________________________ Is he or she prejudiced against any groups, race, or nationalities? _____ if so explain ___ _______________________________________________________________________ With reference to his or her Christian service would you consider the applicant to be dedicated, average, or casual? _____________ Please explain______________________ ________________________________________________________________________ Please comment on the applicants Christian experience___________________________ ________________________________________________________________________ Please comment on the applicants family background____________________________ ________________________________________________________________________ What can YWAM do to aid in the applicants personal development? _______________ ________________________________________________________________________ Please add any other pertinent remarks (Medical, psychological, drug, or alcohol abuse, criminal record or occult practices, etc) ________________________________________ ________________________________________________________________________ Would you recommend the applicant for acceptance into Youth With A Mission? Yes__ Yes with reservation ___No___ Please explain __________________________________ ________________________________________________________________________ Please check Mental Ability Quick to respond_______ Average____ Slow______ Industrious Hard worker_____ Average_____ Lacks persistence____ Reliability Meet obligation___ Average____ Neglectful_____ Cooperativeness Team worker____ Average______ individualistic____ Flexibility Open to change____ Average____ Unyielding_____ Christian Character Well Balanced____ Average____Unstable_______ Disposition Cheerful____ Average______ Passive________ Punctuality Punctual______ Average____ Often late______ Finances Honors finances_____ Average____Neglectful____ Leadership Superior_____ Above____ Average___ Below Avg___ Social Adaptability Very social____ Average _____ Withdrawn_________ Concern for others Very concerned___ Average____ Self absorbed _____ Decision Making Superior_____ Above___ Average ______ Emotion stability Very stable ______ Average_____ Challenged_____ Health Very healthy______ Occasionally sick____Unhealthy___ Ability to follow Superior_____ Above___ Average___ Below Average___ Initiative Superior_____ Above____ Average___ Below Avg___ Personal Appearance Well kept______ Average_______ Needs improvement___ I certify that all the above information is correct in regard to the knowledge I have regarding the applicant. 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