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Application Form 1. COURSE INFORMATION What course are you applying for?

Please attach your photo here, or send

Start date:

it by e-mail

YYYY/MM/DD

2. PERSONAL INFORMATION Name:

As shown on passport

First Name(s)

Middle Name(s)

Surname

Preferred Name: Date of birth:

Gender: Age

Male

Female

Date (YYYY/MM//DD)

Passport: Nationality

Passport Number

Place of Issue

Date of Expiry Please note: You must have a passport valid for at least six months after the end of the school outreach phase for visa application purposes.

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Permanent Address:

Present Address: (if different)

Street: City: County:

State / Province

Postcode:

Zip code

Country: Phone:

Landline

Phone: Mobile

Skype Name: E-mail:

Emergency Contact

(Who would you like us to contact in case of an emergency?)

Full Name:

Relationship to you: Do they speak English?

Yes

No

If ”No”, what language do they speak?

Address: Phone: Landline

E-mail:

Mobile

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3. FAMILY Marital Status:

Married

Engaged

Widow/er

Separated

Divored

Single

Marriage date: YYYY/MM/DD

If you stated separated, divorced or widow/er, please give further explaination:

Spouses Name: Fiancé’s Name

Date of birth: Age

Date (YYYY/MM//DD)

Passport:

Children:

Nationality

Passport Number

Place of Issue

Date of Expiry

How many (if any) children will be accompanying you? Please give their details (use extra sheet if needed, or email us):

# of children

Child 1: Full Name

Date of birth (YYYY/MM/DD)

Gender:

Boy

Girl

School year

Child 2: Full Name

Date of birth (YYYY/MM/DD)

Gender:

Boy

Girl

School year

Child 3: Full Name

Date of birth (YYYY/MM/DD)

Gender:

Boy

School year

Anything else we need to know about your child? Health issues, etc. Please use extra sheet, the ”other info” box in the end or email us.

Girl

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4. EDUCATION, WORK EXPERIENCE & INTERESTS Please summarise your formal school education (from about age 12 and up):

Please summarise your professional training and career, include most recent work:

What are your interests, competencies and skills?

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5. LANGUAGES Please identify the languages you speak and indicate your proficiency: English

1 - Elementary speaking

2 - Limited word proficiency

Other languages:

3 - Minimum professional proficiency 4 - Full professional proficiency 5 - Native tongue proficiency 6 - Mother tongue

6. QUESTIONS ABOUT YOUR BACKGROUND Have you ever been convicted of a criminal offence? Yes

No

Have you ever been involved with the occult? Yes

No

If "Yes" on any of these questions, please explain:

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7. HEALTH Do you consider your health to be:

Good

Average

Poor

Health insurance company: Health insurance number: Do you suffer from any food allergies or intolerances?

Yes

No

Do you follow any special diet?

Yes

No

If ”Yes” to any of the above, please comment:

Do you suffer from any diseases, disabilities or other symptoms?

Yes

No

If ”Yes”, please explain:

Please indicate other handicaps, health problems or sicknesses that we need to know about or which would require special care:

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Are you on any medication or treatment at present?

Yes

No

Yes

No

If ”Yes”, please explain:

Are you allergic to any medication? If ”Yes”, please explain:

Are you currently or have you ever received psychiatric treatment or consultation?

Yes

No

Yes

No

If ”Yes”, please explain:

Do you currently or have you ever struggled with alcohol or drug abuse? If ”Yes”, please explain:

Do you smoke/use tobacco?

Yes

Do you or have you ever had any kind of addiction?

Yes

If ”Yes”, please explain:

No

Occationally

No

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8. CHURCH Church:

Your home church Church Name

Affiliation / Denomination

Pastor: Title

Full Name

E-mail (Pastor)

Church address: Postal address

Phone (Pastor)

E-mail (Church)

Phone (Church)

How long have you attended your church?

9. FINANCES Do you have your complete school fees?

Yes

No

Yes

No

If not, how do you plan on raising the amount you still need?

Do you have any debt at the moment? If ”Yes”, please explain:

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10. REFERENCES We will email your referees a link to the reference form. Please inform them that you have submitted their names as a referee and ensure they know what school you are applying for. If you are applying for a second-level school (not DTS) or staff, at least one reference should come from a recent school leader.

Pastor / Spiritual Leader: Full Name

Relationship to you

Phone

E-mail

Full Name

Relationship to you

Phone

E-mail

Other referee:

Mature friend or similar

11. PERSONAL QUESTIONS Please describe your conversion experience, spiritual growth and any significant spiritual experiences:

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Please describe your present relationship with God, and what He is doing in your life now:

How is your devotional life?

What is your reason for applying for this course?

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What experience, if any, have you had with different cultures?

Have you in any way been involved with YWAM before?

How did you hear about the school?

Is there anything else we need to know? Any additional information you need to add to anything?

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12. CONDITIONS/SIGNATURE In accordance with the Personal Data Act (PDA) I hereby grant Youth With A Mission permission to store and use the information I give them about my family and myself. I confirm that I am aware of my financial responsibility, both before the Lord and before the staff and students of the school. I therefore take full responsibility for the school fee and personal expenses during the time I am involved with Youth With A Mission. I release Youth With A Mission, its agents, staff and volunteers from any liability with regard to personal injury, property damage or loss that may have been caused by the above-mentioned during the time I am involved with Youth With A Mission. I have fully and truthfully filled in all parts of this application. If I am accepted I am willing to follow the course programme and guidelines.

By sending in your applications, you accept the above conditions. Please e-mail your application to: [email protected]

If sending the application by post, please send it to: Ungdom Med Uppgift Restenäs [Name of School] Restenäs 239 459 93 Ljungskile Sweden