School of Missions Application Form Page 1 of 5 School of Missions (SOM) Online Application Form PERSONAL DETAILS Name: (as found in passport) Please select…Mr. Mrs.Miss Family/Surname Legal First Name BIRTH DETAILS Day Please select…12345678910111213141516171819202122232425262728293031 Month Please select…JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year Age Country of Birth: City of Birth Sex malefemale CONTACT INFORMATION Mobile E-mail: Street Address City State/Province Post/Zip Code Country EMERGENCY CONTACT WHO DO WE NEED TO CONTACT IN CASE OF AN EMERGENCY Name: Relationship Phone: CITIZENSHIP Are you Australian or New Zealand citizen? YesNo country of citizenship PASSPORT DETAILS Passport Number: Place of issue: LANGUAGE SPOKEN English YesNo Others: MARITAL STATUS Please select…SingleMarriedDivorcedEngagedWidowed former last name Do you have children? Yes No CHILDREN’S DETAILS Names, birth details, passport details, citizenship (attach extra page if necessary) Page 2 of 5 What is the highest grade level have you completed of Secondary/High School? (Tick ONE box only) Please select…Year 12 or equivalentYear 11 or equivalentYear 10 or equivalentYear 9 or equivalentYear 8 or equivalentNever attended school In which year did you complete that school level? Where and when did you complete your DTS? Where did you complete your DTS? What year? Have you succesfully completed any of the following qualifications? Please select…Bachelor Degree or higherCertificate IV (advanced certificate / technician)Certificate IAdvanced Diploma or Associate DegreeCertificate III (trade certificate)Certificates other than aboveDiploma (Associate diploma)Certificate II Of the following categories, which BEST describes your current employment status? (Tick ONE box only) Please select…Full-time employeeSelf-employed – not employing othersEmployed – unpaid worker in a family businessUnemployed – seeking part-time workPart-time employeeEmployerUnemployed – seeking full-time workUnemployed – not seeking employment Have you ever been convicted of a crime? YesNo (if yes, explain) Have you ever done a DTS with YWAM previously? YesNo If yes, where and when? Do you have the complete school/staff fees? Please select…YesNo If no, how much do you presently have in Australian dollars? How do you anticipate the provision of the remaining amount? If not an Australian resident, have you ever studied in Australia before? Please select…YesNo If yes, please give details of type of study, name and address of education provider Is English your first language? Please select…YesNo Please identify and rank your English language proficiency: Please select…Very wellWellNot WellNot at all Studied English for more than 3 years in school, with a passing grade of at least 80%? Yes No Studied for more than 2 years in an English speaking school? YesNo Have you undertaken TOEFL or IELTS and completed with a passing grade? Page 3 of 5 Personal History 1. Describe how you came to Know Jesus as Lord. 2. Describe your present relationship with the Lord. E.g. prayer life, struggles etc. 3. Please share your vision for the nations. What you hope to accomplish on the SOM? 4. How did you find out about this SOM? Please select…ChurchFacebookFriendGoogle Outreach TeamOther Page 4 of 5 Financial Responsibility All fees are in Australian dollars (AUD). To find out the cost of the course in your currency see: www.xe.com. You will be notified of any changes to this fee schedule prior to arrival. Payments Overview First payment $40 non-refundable application fee due with application Second $500 enrolment deposit plus health cover if required due 3 weeks after acceptance Third $3800 remaining lecture fees due 3 weeks before school starting date Fourth $800-$2500 outreach airfares due on week 6 of school Fifth Ground fees to be determined. Please read the information included in the Student Handbook and Code of Conduct located on the website Medical History and Health Form Please answer all questions. Comment on all positive answers at the end of this page. Have you ever had any of the following? PART A. Personal Details and Medical History Recurrent diarrhoea No Yes Anorexia/Bulimia No Yes Epilepsy No Yes Low blood pressure No Yes Please list any health issues or allergies you have Have you ever had any mental illness? if yes please explain Are you vegetarian? If so please specify. There may not be a vegetarian menu available. Please contact us if you have special requirements. Have you been treated for such disorder by a physician? Yes No Have you now or ever had an eating disorder? Yes No Is this an ongoing problem? Yes No If you have food allergies or sensitivities please list them. Please list all medications you are currently taking under a doctor’s orders. Page 5 of 5 Have you ever had any of the following Allergies? ALLERGY Penicillin No Yes Are you at present under a Doctor’s care for any condition? No Yes Specify Have you ever had any of the following Communicable Diseases? Chicken Pox Measles (Rubella) Measles (Rubeola) Mumps Pertussis Scarlet Fever Tuberculosis Hepatitis AIDS/HIV References Three references are required, one from each of the following: pastor/spiritual leader, employer/business associate/teacher, and a friend (who knows you well). Please send the following link to all 3 of your references for them to fill out an online form: www.ywamsunshinecoast.com/reference/ As soon as we have received all 3 references and your application fee we will process your application. Please fill out the basic contact info below for your references. Spiritual leader/pastor MrMrsMissMs Last Name: First Name: E-mail: Teacher,employer/other MrMrsMissMs First Name: Last Name: E-mail: Friend MrMrsMissMs Last Name: First Name: E-mail: Need assistance with this form?