Application for Training Schools – Section A Page 1 of 5

Application For Training Schools

Youth With A Mission – Los Angeles

School Applying For:

(Please check one)

____ Fall DTS ____ Winter DTS ____ SOMD

____ SOW Year: ___________

Personal Information

Name (Last, First) ____________________________________________________________

Preferred Name_______________________________________________________________

Present Address ______________________________________________________________

City _______________________ St ______ Zip ___________ Country ________________

Phone _______________________________________________________________________

Email _______________________________________________________________________

Permanent Address ___________________________________________________________

City _______________________ St ______ Zip ___________ Country ________________

Phone ___________________________________________________________

Sex: _____ Male _____ Female

Date of Birth (mm/dd/yy)___________________ Citizenship __________________________

Passport/visa information

Passport Number _____________________ Passport Expiration (m/d/y)________________

Place of Issue ________________________________________________________________

Visa Type ______________________ Date of Issue (m/d/y) _________________________

Visa expiration date (m/d/y)_____________________

Note: If you are applying for SOMD, SOW, or SOSM, and have been a student of YWAM -Los Angeles within the last 2 years, you may bypass the rest of this form.

Please continue with Section B of the application.

Mail all forms 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

Application for Training Schools – Section A Page 2 of 5

Family Information

Marital Status

_____ Single _____ Engaged _____ Married _____ Divorced

If engaged:

Has your fiancé applied for the same school?_____ yes _____ no

Has he / she completed a DTS? _____ yes _____ no

Does he/she intend to: _____ yes _____ no

If married, Spouse’s name _____________________________________________________

Name, age, and sex of any child or dependent accompanying you:

Name of parents or legal guardians:_____________________________________________

Do your parents/legal guardians approve of you applying for this school?___ yes ____ no

If no, please explain ___________________________________________________________

Are your parents living?____ yes ____ no Separated? ____ yes ____ no

Divorced? ____ yes ____ no

Church Information

Home church ________________________________________________________________

Church Address ______________________________________________________________

City ______________________ St ______ Zip _________ Country ___________________

Phone ______________________________________________________________________

Pastor’s Name _______________________________________________________________

Church Email ________________________________________________________________

How long have you attended there? _____________________________________________

Are you a member? _____ yes _____ no

Does your pastor approve of you applying for this YWAM School? _____ yes _____ no

If no, why? ___________________________________________________________________

Any previous YWAM or other missions experience? To where and how long?

Mail all forms 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

Application for Training Schools – Section A Page 3 of 5

In Case of Emergency Contact:

Name _______________________________________________________________________

Address ____________________________________________________________________

City ______________________ St ______ Zip ___________ Country _________________

Phone _____________________________ Work phone _______________________________

Email ___________________________________________________________

Relationship _____________________________________________________

Education And Occupational Skills

Highest level of education completed:

Names and dates of Secondary (High) Schools Attended:

Names and dates of Post-Secondary schools (college, university, technical, etc) attended:

What was your major? Did you receive a degree? What type?

Other YWAM Schools, Education or Certificates:

What languages do you speak (list in order of fluency):

If English is your second language (on a scale of 1-5; 5 being best), how well do you:

Speak : _______ Write : _______

Other skills or technical abilities?

Mail all forms 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

Application for Training Schools – Section A Page 4 of 5

Musical abilities / other artistic talents like drama or dance:

Hobbies:

Health Condition

How would you describe your health condition?

_____ Excellent _____ Good _____ Fair _____ Poor

If fair or poor, please explain:

Are you presently taking any medications? _____ yes _____ no

If so, what is the medication(s)?

Describe any dietary needs you may have:

Date of last medical exam (m/d/y) ____________________________________

Do you drink alcoholic beverages? _____ yes _____ no

If so, how often and how much?

Do you have any physical or emotional health issues?

If yes, would these limit your ability to participate in this school?

Mail all forms 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

Application for Training Schools – Section A Page 5 of 5

Personal History

Have you ever been involved in ___ Religious Cults, ___ Other Religions, ___ Occultism,

___ Use of drugs, ___ Alcoholism, ___ Homosexuality?

If so, are there any details that you need and/or want to share that we should be aware of?

Financial Information

Do you have your complete school fees at the present time? _____ yes _____ no

If no, how much do you have? _________________________________

From what source(s) will you receive the remainder?

Do you have any outstanding debts? _____ yes _____ no

If so, explain what is the nature of the debt, how much it is and how you are planning to make payments?

Give names of any dependants you have and to what extent you are obliged to them financially:

Mail all forms 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