Discipleship Training School (DTS) Application

- Thank you for applying to a Dicipleship Training School with YWAM Kauai!
  
  The following items must be submitted and filled out in their entirety. Omitting any of the following information may result in your application not being processed. All of the questions must be completed. If a question does not apply to you please write N/A (not applicable).
  
  Guidelines to Completing Application
  
  1. General Information: Fill this out completely and submit.
  
  2. Photo: Upload a recent photo of yourself. If you would like to send it in, please do so with your application fee.
  
  3. Supplemental Questions completed.
  
  4. Release of Liability Form: All three of these sections must be signed; acknowledgement of financial responsibility, release of liability, and consent for treatment. If you are under 18, be sure to have a parent/guardian sign this form.
  
  5. Base Policy Agreement, Outreach Agreement, and Criminal Background Check: These must be read and signed.
  
  6. Medical Requirements: Health Form Part A - All childhood immunization records must be completed to the best of your ability along with updated adult boosters (within the last five years.)
  
  Health Form Part B - This must be printed out and brought to your doctor to fill out then mailed directly to Registrar. After submitting this form you will receive an email containing Health forms A and B to be printed out, completed, and mailed in. Please allow at least 24 hours for forms to be sent to your email.
  
  7. Confidential References: Three confidential references are required. One reference should be given to each of the following: Friend, Employer/Teacher, and Pastor/Spiritual Mentor. They can access the reference by going onto our website and clicking the link on the APPLY ONLINE page. Be sure to thank them in advance and encourage them to fill it out promptly!
  
  8. Application Fee: Singles: $60.00 USD. This fee is non - refundable and must be forwarded with the application.
  
  9. Passport: Please make sure that your passport expiration date is 9- months from the start of the DTS program that you are applying for. Those who do not have a passport should apply for one immediately.
  
  International Students
  
  Visa: Upon acceptance you will receive more details and a special letter with which formal application for a B-1/2 visa can be made at the US Consulate or Embassy. Please do not make your Visa application without the acceptance letter. Please do not arrange airfare until after you have received your Visa.

General Information
Select which school quarter you are applying for:
Full Name

First NameLast Name
Please upload a recent picture of yourself

Upload a File

Cancelof
Gender
Birth Date

MonthDayYear
Country of Birth
City of Birth
Country of Citizenship
Do you have a passport?
Date of Passport Expiration

MonthDayYear
If not a US Citizen, do you have a visa?
If Yes, what type?
What are the dates/ time periods?
Marital Status
Spouse's Name

First NameLast Name
Anniversary

MonthDayYear
Number of Children Accompanying you
Do they have any disabilities we should be aware of?
If your spouse and/or children do not live with you, please explain.
Permanent Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Present Address (if different than permanent)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Last date that you will be living there

MonthDayYear
Emergency Contact
Full Name

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Education History
High School Name
Date of Graduation

MonthDayYear
-OR-
College/Vocational school name
Date of Graduation

MonthDayYear
Other
Is English your first language?
If English is your second language, how fluently do you speak and write in English?
Do you speak more than one language?
If yes please list all languages
Food Allegries / Dietary Restrictions:
Food Allgeries:
If yes, please explain:
Any Dietary Restrictions (Dairy Free, Gluten Free, Vegetarian, Vegan)? If so, is this a medical choice or personal choice?
Financial Support
Do you have all of your school fees?
If yes, from where? If no, what is your plan to raise fees?
Do you have any debt?
Confidential References Information
*Don't forget to have them fill out your references and send them to us.
Employer/Teacher

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Friend

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Pastor/Spiritual Mentor

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Church Involvement
Home Church Name
Pastor's Name

First NameLast Name
Describe your present relationship with your local church and leaders, and your involvement there.
Are they supportive of your involvement in mission work? How?
Supplemental Questions
How would you describe yourself?
Describe how you came to know the Lord and what your present relationship with him is like.
What is your purpose in attending the DTS? What are your expectations?
How often do you read your Bible?
What's your greatest strength? Weakness?
What do you enjoy doing and spend most of your personal time on?
Do you have any occupational skills, musical ability or other talents?
Do you feel called to missions work? please explain.
How would you describe your relationship with your family? Are they supportive of your call to missions?
What types of people do you find it hard to get along with and why?
How do you plan on handling these difficult situations?
Have you've been a part of any missions work locally / abroad? Short or long-term?
How did you find out about YWAM? DTS? YWAM Kaua'i?
Have you ever served with any YWAM ministries? If yes, where? When? and with which ministry?
Do you have any questions for us?
Do you have any difficult situations to deal with in regard to attending the DTS? How can we pray for you?
Health Form-Part A
Are you presently under a doctor's care?
If yes, please specify.
Do you have any physical disability, special diet, or mental illness history that we should be aware of?
If yes, please explain
Are you, or have you ever received counseling?
Are you taking any medication at this time?
If yes, please specify: (Arrange to bring all of your long term medication with you)
Are you receiving,or have you ever received compensation in any form for a disability?
If yes, please specify.

Childhood Immunizations

Rows	MO/D/Y	MO/D/Y	MO/D/Y
Diphtheria
Tetanus
Pertussis
Polio
Rubella
Measles
Mumps
Hepatitis A&B
Hepatitus C

Adult Boosters

Rows	MO/D/Y	MO/D/Y	MO/D/Y
Diphtheria
Tetanus
Pertussis
Polio
Rubella
Measles
Mumps
Hepatitis A&B
Hepatitis C

Have you ever had any of the following?

Rows	Yes	No
Mental/Nervous Disorder
Head Injury
Paralysis
Epilepsy
Insomnia
Weakness
Fainting Spells
Shortness of Breath
Asthma
Hay Fever
Allergies
Stomach Problems
Intestinal Problems
Gall Bladder Problems
Chronic Diarrhea
Kidney Disease
Tumor/Cancer
Skin Condition
Jaundice
Rheumatism/Arthritis
Back Problems
Dislocation of Joints
Broken Bones
Heart Problems
Diabetes
Anemia
High Blood Pressure
Low Blood Pressure
Seeing Problems
Hearing Problems
Speaking Problems
Chronic Headaches
Chronic Ear Infections
Chronic Nose Bleeds
Chicken Pox
Measles
Mumps (Rubella)
Pertussis
Scarlet Fever
Tuberculosis
Hepatitis
Venereal Disease

Female Only

Rows	Yes	No
Irregular Period
Severe Cramps
Excessive Flow
Currently Pregnant

Surgeries Received

Rows	Date	Type of Surgery	Outcome/Long-Term Effects
1
2
3

- I have completed all portions of this application to the school, course or outreach for which I am applying. If Youth With A Mission accepts me, I will abide by the Spirit, rules, and schedule of the school.
- My initials below signify that I agree to the above terms.
Initial
- Release of Liability
- I/We do hereby release Youth With A Mission, Inc. It’s agents, employees, and volunteer assistants from any liability whatsoever arising out of any injury, damage or loss which may be sustained by said person during the course of involvement with Youth With A Mission.
- My initials below signify that I agree to the above terms.
Initial
- Acknowledgement of Financial Responsibility
- I confirm that I understand that payment of the required school tuition fees must be made upon or before my arrival, unless otherwise arranged with leadership prior to the beginning date of the course, and I agree to do so. I am fully aware of my financial obligation, both to the Lord and to the students and staff of the school. I also understand that should I choose to leave the program prior to completion I am not entitled to a refund. I therefore promise to keep my word and pay in a timely manner all personal expenses incurred during my involvement with Youth With A Mission. I also commit to take all the necessary steps to meet this promise, and accept the help and suggestions of my future staff.
  
  My initials below signify that I agree to the above terms.
Initial
- Consent for Treatment
- In case of emergency, I/We hereby agree to the performance of such treatment, including anesthesia and surgery, that the attending doctor or physician may deem necessary.
- My initials below signify that I agree to the above terms.
Initial
- Base Policy Agreement
- Youth With A Mission is for Christians who are committed to the Great Commission (Matthew 28:18-19), which includes living a godly life worthy of example. Your time here will be enjoyable, rewarding and challenging. We are committed to helping you grow as a disciple of Jesus and we look forward to your being here. However, being a disciple of Jesus includes taking responsibility for your life and conduct. Please read the following carefully.
  
  Approximately 90% of the evangelical community of the world (Africa, Asia, and the Americas) considers alcoholic drinks and tobacco products totally off limits. Often in these contexts, alcohol and tobacco use is viewed as a sign that someone either does not know God or is turning away from Him. God has blessed YWAM with training bases that draw in and send out "internationals: so it is important that as a family we understand and honor one another in our conversations and actions.
  
  We also want our staff to be free from bondage. If you are struggling in any area, please be open and honest with your leaders. If you are asking these questions and realizing you are doing things out of unhealthy motivations, we want to be here to walk you through to freedom and discipleship. It is when we are not open and honest about these issues that we begin to get in trouble.
  
  We do ask that during your time here, you agree to refrain from the use of alcohol or tobacco products during your time on the island of Kaua'i. As well, we ask that you agree to absolutely no drunkenness during your time at YWAM Kaua'i, and no use of illegal drugs, or prescription drugs that are not yours. We also ask that if you are addicted to any substances or notice addictive patterns in your life that you would be open and honest with us from the beginning of the application process.
  
  I agree to abstain from the use of tobacco and alcohol on island. I also agree to refrain from the use of illegal drugs, prescription drugs that are not my own, and drunkenness. If there is an issue with any of these things in my life, I will go to one of my leaders to be open, honest, and to welcome accountability in my life. I understand that if my leaders find out things regarding alcohol, tobacco or drugs about me from someone else, they have the right to question me as well as enforce any degree of discipline they see fit. I understand that if I break this contract, it could be grounds for dismissal.
  
  My initials below signify that I agree to the above terms.*
Initial
Background Check
Full Legal Name

First NameMiddle NameLast NameSuffix
Have you ever been convicted of a crime?
If yes, please explain
- Applicant’s signature: I have reviewed and completed this form as applicable to me. I give YOUTH WITH A MISSION KAUAI permission to verify any information I have provided. This authorization shall continue to be effective until revoked by me. A photocopy or facsimile copy of this consent shall be as effective as the original. By my signature, I affirm that all information on this form is true and accurate.
- My initials below signify that I agree to the above terms.
Initial
- Outreach Agreement
- Because my purpose in joining Youth With A Mission is to take the gospel to the nations, I agree to submit to its leadership and policies and to conduct myself in a way that brings honor to the Lord Jesus Christ.
  
  I understand that outreach destinations and dates are subject to change and that YWAM reserves the right to change or cancel outreaches in the event of a natural disaster, political crisis, and/or ministry-related difficulties. Should an outreach be cancelled, YWAM will work with me to reassign me to another outreach.
  
  YWAM is not liable in case of illness, accident, death, or unexpected travel expenses. In case of accidental death, Youth With A Mission Kauai cannot cover the cost of burial in the country of service, nor the cost of shipping the body to another country for burial. Family members must incur all burial related expenses. Some nations, by law, require immediate entombment or cremation.
  
  Because YWAM is registered with the Internal Revenue Service as a 501(c)3 non-profit organization, donations made for school fees are considered tuition and are NOT tax-deductible.
  
  I understand that YWAM Kauai does not refund contributions it receives for outreaches.
  
  I understand that if I fail to abide by this agreement I will be asked to leave the field at my own expense.
  
  My signature below (and that of my parent or legal guardian if I am under 18) certifies my approval of this agreement and intention to comply with its contents.
- My initials below signify that I agree to the above terms.
Initial

- Health Form- Part B
  
  This form must be printed and brought to your doctor for a physical. Once completed, it is to be mailed directly to YWAM KAUAI Registrar.
- To the applicant:
  
  Upon acceptance, we recommend you obtain the following immunizations (before arrival to YWAM, Kauai): Typhoid, Hepatitis A&B, and Tetanus Booster (if you have not received one in the last five years). These are usually recommended by health agencies (Center of Disease Control, etc.) regardless of where you travel. Due to varied outreach locations, other immunizations, and Malaria medication may be recommended and can be obtained before outreach. If you have ever been immunized for Cholera, Typhoid, or Yellow Fever, please check the box below and bring that information with you. If you were born after 1957, you will need a Measles booster (total of 2 Measles immunizations). Those born before 1957 are considered immune from Measles. Please be prepared financially to cover the cost of additional immunizations. If you decide NOT to receive the recommended immunizations, you will be asked to sign a waiver stating that you understand the specific immunizations recommended and are choosing not to obtain them. Please check the box below if you are NOT obtaining the recommended immunizations.
- To the physician:
  
  Please review the information in Part A, please treat all conditions that you feel require treatment and notify us of any problem that you feel we should know about following the medical evaluation. As certain conditions such as diabetes, epilepsy, heart disease and obesity may affect acceptance, please ensure that pertinent information in these areas have been included.
Name of Applicant

First NameLast Name
Date of Physical

MonthDayYear
Name of Physician

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Has the patient had the following immunizations?

Rows	Yes	No
Cholera
Typhoid
Yellow Fever

Tuberculosis Control- this must be done within six months of the school. A chest x-ray is required if test is positive.

Rows	Date	Result	Testing Facility
Skin Test
Chest X-RAY

Vital Signs

Rows	Comments
Height
Weight
Pulse
Blood Pressure
Blood Type
Urinalysis

Systems check: are there any abnormalities of the following system?

Rows	Yes	No	Comments
E.N.T.
Teeth
Ophthalmologic
Neurological
Cardiovascular
Respertory
Musculoskeletal
Endocrine
Lymphatic
Dermatological
Hernial Office
Urological
Psychiatric

You can pay your application fee online via paypal using the link below, or send a check in the mail to

YWAM Kauai

Po Box 260

Waimea HI, 96796
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Application Fee$60.00

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