DTS Application, Los Angeles – Section C

DISCIPLESHIP TRAINING SCHOOL

Youth With A Mission - Los Angeles

Thank you for applying to YWAM Los Angeles! May you know the Lord’s grace as you seek His direction. In order for us to process your application, we must receive the following completed forms. Husbands and wives enrolling as students must complete separate applications.

Checklist for Completing Application

Important: Answer each question on all forms. For questions that do not apply to you, answer with: N/A

q DTS Application Form. Section A and B must be filled out either on-line or in printed form. This section, C, must be completed in full.

q DTS Registration Fee. A non-refundable registration fee is to be forwarded with your completed application. The fee is required in order to process your application. All payments received for the DTS must be in U.S. currency. See the Financial Policy for registration fee amounts.

q DTS Financial Policy. Please review carefully, sign and date.

q Confidential Health Form. Please provide this information, failure to do so completely could affect your chances of acceptance.

q Physician’s Form. Please have a physician complete this form.

q Pastor’s Reference. Please send this form to your pastor or spiritual leader for completion. Provide them with a stamped and addressed envelope.

q Employer or Teacher’s Reference. Please send this form to an employer or teacher for completion. Provide them with a stamped and addressed envelope.

q Friend’s Reference. Please send this form to a friend for completion. Provide them with a stamped and addressed envelope.

q Consent Form. Please read carefully and sign each portion of the form. Also, if you are a minor (under 18 years of age), please have your parent or guardian sign as well.

q Passport size picture.

Applications will not be reviewed until all parts are received.

Mail all application items to:

YOUTH WITH A MISSION

Attn: Registrar

11141 Osborne Street

Lake View Terrace, California 91342, USA

Phone: +1 818-896-2755, Fax: +1 818-897-6738

E-mail: registrar@ywamla.org

DTS Application, Los Angeles – Section C

DISCIPLESHIP TRAINING SCHOOL

Youth With A Mission - Los Angeles

FINANCIAL POLICY

TUITION AND FEES

Registration Fee: This fee must be included with your application in order for consideration of acceptance. This fee is non-refundable and must be sent in U.S. currency. Singles: $35 Couples: $50

Tuition Fee: (Lecture Phase)

Please refer to our website or contact the Registrar at (818) 896 2755 ext. 230, or email registrar@ywamla.org for current prices.

Note: Outreach fees are not included in the tuition cost.

TUITION FEE POLICIES

Ø Each student is expected to send $500 ($1,000 per couple) as soon as possible after being accepted into the school to reserve their enrollment.

Ø There will be a $50 discount for single students able to pay their tuition in full at least 30 days prior to the beginning of the school for which they are accepted. This can be deducted from the current tuition fee.

Ø The balance of tuition must be paid in full before the school begins. Any student arriving without the full tuition fees will not be able to attend, unless the school director has given approval.

Ø All payments must be made in U.S. funds.

Ø All personal expenses incurred while involved with YWAM - Los Angeles are the responsibility of the student.

Ø Variations to these policies are rare and require written approval by the school director. If you desire to apply for an exception, please contact the school director for help in developing a suitable proposal. A written copy of the proposal must be submitted at least two weeks prior to registration day. If the financing source is other than the student (e.g. friend, relative, church, etc.), a letter from the source verifying the means of payment must be presented.

Tuition fees cover school costs such as ground transportation, speaker expenses, meals and housing. Tuition does not include outreach expenses, expenses of personal care or study materials. In order to maintain minimal cost for the school, each student will be involved in work duties for 10 hours per week. This involves jobs such as cleaning, cooking, landscaping, maintenance, etc.

Tuition fees are not tax deductible. This is a college course and is viewed by the IRS the same as any other college/university course. After completion of the course, funds received for support may be tax deductible.

REFUND POLICY

It is expected that when students enroll, they will continue through the entire course. However, termination or withdrawal from the program may occur due to emergencies or disciplinary reasons. Refunds are disbursed as follows:

Any time during:

the first week: 80% refund of tuition the 5^th week: 29% refund of tuition

the 2^nd week: 64% refund the 6^th week: 23% refund

the 3^rd week: 51% refund the 7^th week: 21% refund

the 4^th week: 36% refund the 8^th week: 17% refund

I have carefully read the above financial policy and hereby agree to comply with all the terms outlined.

Applicant Signature ___________________ Date

DTS Application, Los Angeles – Section C Page 1 of 2

Discipleship Training School

Confidential Health Form

ATTENTION APPLICANT

Please complete the information below and provide a stamped envelope addressed to YWAM –

Los Angeles for the doctor completing this form.

Applicant Name: ______________________________________________________________

DTS Dates: _________________________

1. Blood Type 2. Height (in feet, please)

3. Weight (in pounds, please)

4. Explain any recent weight changes:

5. List all important past surgeries, X-rays, illnesses, injuries, or handicaps. (Please explain): ____________________

_______________________________________________________________________________________________

6. Have you ever had a severe emotional breakdown, or been diagnosed with a mental illness (i.e. depression)? If yes, please describe: _________________________________________________________________________________

_______________________________________________________________________________________________

7. Have you ever used drugs for other than medical purposes? If yes, when? _________________________________

______________________________________________________________________________________________________________________________________________________________________________________________

8. Name of drug ________________________________ For how long ______________________

9. Have you ever had or do you have any of the following? If yes, please describe on a separate piece of paper.

Skin Condition  Yes  No Heart Condition  Yes  No

Jaundice  Yes  No Rheumatism/Arthritis  Yes  No

High Blood Pressure  Yes  No Shortness of breath  Yes  No

Low Blood Pressure  Yes  No Stomach ulcer  Yes  No

Intestinal trouble  Yes  No Gall bladder problems  Yes  No

Recurrent diarrhea  Yes  No Eye trouble  Yes  No

Migraines  Yes  No Ear trouble  Yes  No

Head injury  Yes  No Diabetes  Yes  No

Venereal disease  Yes No Kidney disease  Yes  No

Fainting spells  Yes  No Epilepsy  Yes  No

Nervous disorders  Yes  No Anemia  Yes  No

Weakness  Yes  No Hepatitis  Yes  No

Paralysis  Yes  No Hepatitis type ____________________

DTS Application, Los Angeles – Section C Page 2 of 2

Discipleship Training School

Confidential Health Form

Cont.

Insomnia  Yes  No Broken bones  Yes  No

Back Problems  Yes  No Asthma  Yes  No

Hay fever  Yes  No Tumor/Cancer  Yes  No

Dislocation of joints  Yes  No

Are you allergic to:

Penicillin Yes  No Food  Yes  No Specify:_________________

Serum Yes  No Other  Yes  No Specify:_________________

Sulfonamides Yes  No

10. Have you ever had any of the following communicable diseases?

Chicken Pox Yes  No Measles (Rubella) Yes  No

Scarlet Fever Yes  No Mumps Yes  No

Pertussis Yes  No Other: Yes  No

Tuberculosis Yes  No Specify: ____________________________

11. Immunization Record Dates (Month/Year)

DPT/Td (Series of 3)  Yes  No /

Td Booster  Yes  No /

Tetanus Booster  Yes  No /

Polio (Series of 3)  Yes  No /

Polio Booster (as adult)  Yes  No /

Measles (MMR) – (Series of 2)  Yes  No /

Rubella  Yes  No /

Typhoid (Series of 3)  Yes  No /

Cholera  Yes  No /

Smallpox  Yes  No /

Yellow Fever  Yes  No /

BCG  Yes  No /

Hepatitis A (Series of 2)  Yes  No /

Hepatitis B (Series of 3)  Yes  No /

12. Have any of your relatives ever had any of the following? Relationship

Tuberculosis  Yes  No

Diabetes  Yes  No

Kidney Disease  Yes  No

Heart Disease  Yes  No

Arthritis  Yes  No

Stomach Disease  Yes  No

Asthma, Hay Fever  Yes  No

Epilepsy  Yes  No

Females only:

Irregular periods Yes  No

Medication for Menstrual cycle Yes  No

Are you pregnant? Yes  No If yes, what is your due date? (mm/dd/yy) / /

Past Pregnancies? Yes  No

Mail form to: Youth With A Mission – Los Angeles, Attn. Registrar

11141 Osborne Street, Lake View Terrace, CA 91342, USA

Phone: +1 818-896-2755, Fax: +1 818-897-6738

DTS Application, Los Angeles – Section C Page 1 of 3

Discipleship Training School

Medical Report

ATTENTION APPLICANT

Please complete the information below and provide a stamped envelope addressed to YWAM –

Los Angeles for the doctor completing this form.

Applicant Name: ______________________________________________________________

DTS Dates: _________________________

To the Doctor

Please fill out this medical report bearing in mind that the applicant could travel and work in almost any country in the world, often in primitive and stressful conditions.

Doctor’s Name: _______________________________________________________________________________

Street Address: __________________________________________________________________________________

City and State: _________________________ Zip or Postal Code and Country: ____________________________

Doctor’s Signature: _____________________________________________________________

Date (mm/dd/yy) ______/______/______

General Health

Is the patient able to walk six miles in a day?  Yes  No If no, please explain:__________________________

_______________________________________________________________________________________________

Could the patient carry out reasonably strenuous physical work on a daily basis?  Yes  No

If no, please explain: _____________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________

Applicant’s Height (in feet and inches, please)

Applicant’s Weight ____________________ (in pounds, please)

Is the patient hindered from doing anything due to being over or under weight?  Yes  No

If so, is this a risk to their health? Yes  No

If yes to either, please explain: ______________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________

DTS Application, Los Angeles – Section C Page 2 of 3

Discipleship Training School

Medical Report

Is the patient under medical supervision for any condition?  Yes  No

If yes, please explain: _____________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________

Is the patient free from infectious diseases? Yes  No

If no, please explain (This may be a requirement of the authorities of the country to which the applicant is traveling).

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Does the patient suffer from any of the following?

If yes, please explain:

Epilepsy/seizures  Yes  No __________________________________________________

Anemia  Yes  No __________________________________________________

Hypertension  Yes  No __________________________________________________

Mental Problems  Yes  No __________________________________________________

Adverse reactions to stressful situations  Yes  No __________________________________________________

Allergies  Yes  No __________________________________________________

Any other serious conditions  Yes  No __________________________________________________

List any prescription medications that the patient is taking: _______________________________________________

_______________________________________________________________________________________________

Are there any other facts that might be relevant? ________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________

Based on the information given, do you consider the person to be in good health?  Yes  No

Any Comments: _________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________

DTS Application, Los Angeles – Section C Page 3 of 3

Discipleship Training School

Medical Report

Please list all the serious illnesses and operations that the patient has had. (This means any illness requiring hospital treatment or non-hospital treatment lasting more than a month, or has had a long-term effect upon the person’s health).

Illness/Operation Date (mm/dd/yy)

Outcome

/ /

List any serious relevant illnesses in the person’s family.

Family Member Illness

FOR WOMEN ONLY

Does the patient have any problems with her menstrual cycle?  Yes  No

If yes, please explain: _____________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________

Is the person pregnant?  Yes  No

If so, when is the baby due? Day ________ Month __________ Year __________

Past pregnancies?  Yes  No

If so, what was the outcome?_________________________________________________________________

____________________________________________________________________________________________________________________________________________________________

Thank you so much for your cooperation,

YWAM-Los Angeles DTS staff

Mail form to: Youth With A Mission – Los Angeles, Attn. Registrar

11141 Osborne Street, Lake View Terrace, CA 91342, USA

Phone: +1 818-896-2755, Fax: +1 818-897-6738

DTS Application, Los Angeles – Section C Page 1 of 4

Discipleship Training School

PASTOR’S REFERENCE

ATTENTION APPLICANT

Please complete the information below and provide a stamped envelope addressed to YWAM –

Los Angeles for the person completing the reference.

Applicant name: ________________________________________________________________

DTS dates: ____________________________________________

I, the above named applicant, waive any right I have to read or obtain copies of this reference form knowing that this waiver is not required for admission.

Applicant’s signature: ______________________________ Date: (mm/dd/yy) _______/________/_________

Dear Pastor:

The above applicant has applied to attend a training program with Youth With A Mission - Los Angeles. Youth With A Mission (YWAM) is an international, interdenominational Christian missions organization. Founded in 1960, YWAM now has centers in over 180 nations on six continents. Its purposes include training, challenging and equipping Christians to fulfill Christ’s command to “ Go, therefore and make disciples of all nations.”

We would appreciate if you supplied the information requested on this form, in order to aid us in evaluating the applicant’s suitability for admission. Serious consideration will be given to your comments; therefore, we ask that you complete this form carefully. The applicant cannot be considered for admission until all references are received. Your speedy completion of this form would be very much appreciated. Please feel free to use additional paper to answer any of the questions.

I have known the applicant for _______ years.

On a scale of 1 to 5, how well do you know the applicant? ________ ( 1= very little, 5= intimately)

Pastor, how long has the applicant attended your church? ___________________

Pastor, in what activities has the applicant participated since attending your church?

______________________________________________________________________________________________

In your association with the applicant, what has been the level of commitment you have seen exemplified?

 Faithful  Inconsistent  Other Please explain: __________________________________________________

_______________________________________________________________________________________________

DTS Application, Los Angeles – Section C Page 2 of 4

Discipleship Training School

PASTOR’S REFERENCE

Please check words that describe the applicant. Choose only 4-5 words that stand out to you:

 Teachable  Easily Discouraged  Humorous  Easily Embarrassed

 Tolerant  Perfectionist  Moody  Easily Offended

 Enthusiastic  Nervous  Fearful  Dependable

 Committed  Lacking Humor  Domineering  Self motivated

 Good Listener  Prejudiced  Flexible  Patient

 Understanding  Anxious  Critical  Wise

 Disciplined  Stable  Peaceful  Apathetic

Please check the following and comment where necessary. If Poor or Below Average is marked, please explain below.

	Excellent	Above Average	Average	Below Average	Poor
Initiative
Response to change
Social Adaptability
Communication Skills
Ability to Follow
Ability to receive correction
Self Confidence
Leadership
Concern for Others
Willingness to Serve
Judgment/ Decision making
Emotional Stability
Health
Personal Appearance

Comments: _____________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________

Due to the cultural and environmental context of the school, adjustments may 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 and stability.

How does the applicant react in trying situations? (Check one)

 Withdraws  Gets discouraged  Gets angry  Meets constructively

 Accepts patiently  Other _____________________________________________________

DTS Application, Los Angeles – Section C Page 3 of 4

Discipleship Training School

PASTOR’S REFERENCE

Has the applicant proven on any occasion to be unreliable, dishonest, or of questionable character?  Yes  No

If yes, please explain:

_______________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________

Please check which one best describes the applicant:

Mental Ability  Quick to Comprehend  Average  Slow To Comprehend

Industrious  Hard Worker  Average  Lacks Persistence

Reliable  Meets Obligations  Average  Neglects Obligations

Teamwork  Works Well With Others  Average  Avoids Group Actions

Flexibility  Open To Change  Average  Unyielding

Christian Character  Well-Balanced  Average  Unstable

Disposition  Cheerful  Average  Passive

Punctuality  Punctual  Average  Often Late

Financial Responsibility  Honors Obligations  Average  Neglectful

Comments: _____________________________________________________________________________________

Please, check one of the following:

 Applicant is outstandingly mature, has proven ability to operate under stress and pressure

 Applicant is more mature and emotionally stable than average.

 Applicant possesses adequate emotional stability and maturity.

 Experience has shown that the applicant might not be able to endure stress.

Does the applicant display high moral standards?  Yes  No

If no, please explain: ______________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________

Please comment on the applicant’s family background (if known): _________________________________________

Please add any other relevant remarks that you think we should know about the applicant: _______________________

DTS Application, Los Angeles – Section C Page 4 of 4

Discipleship Training School

PASTOR’S REFERENCE

Pastor, if you feel it is right for the applicant to participate in this training program, would you offer any pastoral counsel to us in helping him/her adjust to a foreign country and new situation? ________________________________

______________________________________________________________________________________________________________________________________________________________________________________________

Pastor, is your congregation or group standing behind the applicant with total enthusiasm?  Yes  No

If no, please explain: ______________________________________________________________________________

_______________________________________________________________________________________________

Would you recommend the applicant for acceptance by YWAM?  Yes  No  Hesitant

If hesitant or no, please explain: _____________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________

Please check any of the following that you feel are motivating the applicant to become a student in this training program:

 Personal Growth  Christian Service  Adventure  Receive Help

 Receive Discipleship  To Spread The Gospel  Desire To Help Others

 Travel  Get Away From Unpleasant Circumstances

Pastor, we desire to come along side your ministry to the applicant by continuing the discipling process. If you have any questions or input, please do not hesitate to contact us.

Your Name: ____________________________________________________________________________________

Street Address___________________________________________________________________________________

City and State__________________________________Zip or Postal Code and Country________________________

Telephone Number home: ____________________________ Work Phone: ________________________________

Email: _____________________________________

Signature: __________________________________ Date: _________/__________/__________

Month Day Year

Do you want to know more about YWAM - Los Angeles?  Yes  No

Please direct all forms to the address below.

Thank you so much for your cooperation,

YWAM-Los Angeles DTS staff

Mail form to: Youth With A Mission – Los Angeles, Attn. Registrar

11141 Osborne Street, Lake View Terrace, CA 91342, USA

Phone: +1 818-896-2755, Fax: +1 818-897-6738

DTS Application, Los Angeles – Section C Page 1 of 4

Discipleship Training School

EMPLOYER’S OR TEACHER’S REFERENCE

ATTENTION APPLICANT

Please complete the information below and provide a stamped envelope addressed to YWAM –

Los Angeles for the person completing the reference.

Applicant name: ________________________________________________________________

DTS dates: ____________________________________________

I, the above named applicant, waive any right I have to read or obtain copies of this reference form knowing that this waiver is not required for admission.

Applicant’s signature: _____________________________________ Date: (mm/dd/yy) _______/________/_______

To the person filling out this form:

We would appreciate if you supplied the information requested on this form, in order to aid us in evaluating the applicant’s suitability for admission. Serious consideration will be given to your comments; therefore, we ask that you complete this form carefully. Please be sure to mail this form directly to the Youth With A Mission base address indicated below. Your early response will be appreciated as the applicant’s file cannot be considered until all references are received by this office. Please feel free to use additional paper to answer any of the questions.

Thank you for taking the time to help us in this way. We sincerely appreciate your cooperation.

How long have you been acquainted with the applicant? Years__________ Months__________

What is your relationship to him/her? (teacher, pastor, friend, etc.) _______________________

DTS Application, Los Angeles – Section C Page 2 of 4

Discipleship Training School

EMPLOYER’S OR TEACHER’S REFERENCE

Evaluation of Applicant’s Emotional and Spiritual Maturity

A Discipleship Training School student must be able to adjust him/herself readily to unaccustomed living conditions and new social situations. Adjustments may have to be made as to diet, social customs, climate changes, etc. Keeping in mind the challenge of these unusual demands, please rate this applicant by placing a check under each of the following categories:

Physical Condition Attractiveness Intelligence

 Frequently incapacitated  Avoided by others  Learns and thinks slowly

 Somewhat below par  Tolerated by others  Average mental ability

 Fairly healthy  Liked by others  Alert: has good mind

 Good health  Well-liked by others  Brilliant: exceptional

Responsiveness Emotional Resilience Christian Character

(to the feelings and needs of others) (in trying situations)  Relatively superficial

 Slow to sense how others feel  Gets angry, impulsive  Over-emotional

 Reasonably responsive  Withdraws  Genuine but mild

 Understanding & thoughtful  Gets discouraged easily  Rich and growing

 Exceptionally responsive  Meets constructively  Warmly contagious

Leadership Achievement

(ability to inspire others & (ability to formulate, execute,

maintain their confidence) and carry plans to conclusion)

 Makes no effort to lead  Starts but does not finish

 Tries but lacks ability  Does only what is assigned

 Has some leadership promise  Meets average expectations

 Outstanding ability to lead  Superior creative ability

Willingness to Serve Teamwork

 Reluctant to serve  Frequently causes friction

 Motives confused  Insists on having own way

 Usually willing to serve  Usually cooperative

 Eager to serve as needed  Works well with others

Listed below are some of the qualities that describe a leader. Please use the letters W, D, A, M, or S to rate as follows: W=Weak; D=Developing; A=Average; M=Mature; S=Strong

*Please comment if Weak is denoted.

____ Positive, contagious spirit ____ Able to make decisions

____ Ability to motivate others ____ Assurance of God’s calling

____ Social poise ____ Self-confidence

____ Teachable attitude ____ Able to receive criticism

____ Ability to communicate ____ Respect for strong conviction of others

____ Emotionally stable ____ Able to deal with inter-personal problems

Check any of the following that you feel is motivating the applicant to do a Discipleship Training School:

 Christian Service  Receive help, counseling  Adventure

 Desire to spread the Gospel  Escape from bad situation  Discipleship

 Desire to help others  Travel  Personal Growth

 Other (specify):

DTS Application, Los Angeles – Section C Page 3 of 4

Discipleship Training School

EMPLOYER’S OR TEACHER’S REFERENCE

Listed below are some of the tendencies that, if present in the applicant, may hinder the DTS experience for the applicant and other students. Please underline words or descriptions that may pertain to the applicant.

Easily embarrassed, offended or discouraged

Frequently worried, anxious, nervous or tense, given to moods

Prejudiced toward groups, races, or nationalities

Impatient, intolerant, argumentative, domineering, “cocky” or critical of others

Given to exclusive and absorbing infatuations

Unable to cope with stress, erratic in attitudes or action

Uncontrolled anger

Lack of respect for leadership or structure (i.e. rules)

If the applicant seems relatively free from all such tendencies, check here _______

If you have noted any of these or similar limitations in the applicant, please specify on a separate sheet.

Please comment briefly on the family and social background of the applicant: ______________________________

_____________________________________________________________________________________________

Is the applicant financially responsible?  Yes  No If no, please explain. _______________________________________________________________________________________________

Describe any significant physical, psychological, or addictive behavioral problems the applicant has faced. ____________________________________________________________________________________________

____________________________________________________________________________________________

What do you feel YWAM can do to aid the applicant’s personal/spiritual development? ______________________

_____________________________________________________________________________________________

Please use a separate sheet of paper to elaborate if the answer is “yes” to any of the following three questions:

a) Has the applicant proven on any occasion to be unreliable, dishonest, or to have questionable character?

b) As far as you know, has the applicant ever been arrested for any offense?

c) To your knowledge, has the applicant ever been involved in drug abuse, promiscuity, or the occult?

DTS Application, Los Angeles – Section C Page 4 of 4

Discipleship Training School

EMPLOYER’S OR TEACHER’S REFERENCE

What is your overall evaluation of the applicant’s promise as a Discipleship Training School Student?

 Is definitely unsuited  Is an average prospect

 Is not suited at this time  Is an above average prospect

 Is a good prospect, but I do have some  Is an exceptional prospect

reservations

Evaluation of Applicant’s Skill, Training, Profession, or Trade

To be answered only by those who are qualified to evaluate applicant’s skill.

Please state applicant’s skill/trade___________________________________________________________________

 Incompetent  Highly competent

 Doubtful  Superior in competence

 Adequate

What other skills or areas of competence? _____________________________________________________________

_______________________________________________________________________________________________

I declare that the contents of this reference form are correct to the best of my knowledge.

Your Name (please print) _____________________________________________ Date __________________

Month/Day/Year

Address __________________________________________________________________________________

__________________________________________________________________________________

Signature _____________________________________________ Telephone ______________________

Would you like to receive further information about Youth With A Mission?  Yes  No

Thank you so much for your cooperation,

YWAM-Los Angeles DTS staff

Mail form to: Youth With A Mission – Los Angeles, Attn. Registrar

11141 Osborne Street, Lake View Terrace, CA 91342, USA

Phone: +1 818-896-2755, Fax: +1 818-897-6738

DTS Application, Los Angeles – Section C Page 1 of 4

Discipleship Training School

FRIEND’S REFERENCE

ATTENTION APPLICANT

Please complete the information below and provide a stamped envelope addressed to YWAM –

Los Angeles for the person completing the reference.

Applicant name: ________________________________________________________________

DTS dates: ____________________________________________

I, the above named applicant, waive any right I have to read or obtain copies of this reference form knowing that this waiver is not required for admission.

Applicant’s signature: _____________________________________ Date: (mm/dd/yy) _______/________/_______

To the person filling out this form:

We would appreciate if you supplied the information requested on this form, in order to aid us in evaluating the applicant’s suitability for admission. Serious consideration will be given to your comments; therefore, we ask that you complete this form carefully. Please be sure to mail this form directly to the Youth With A Mission base address indicated below. Your early response will be appreciated as the applicant’s file cannot be considered until all references are received by this office. Please feel free to use additional paper to answer any of the questions.

Thank you for taking the time to help us in this way. We sincerely appreciate your cooperation.

How long have you been acquainted with the applicant? Years__________ Months__________

What is your relationship to him/her? (teacher, pastor, friend, etc.) _______________________

DTS Application, Los Angeles – Section C Page 2 of 4

Discipleship Training School

FRIEND’S REFERENCE