Part Time MDTS Application Form

1- Name *

1- Name

First Name

Last Name

2- Applicant Email Address *

3- I am Applying for

Select one option in the list

4- Applicant Birth Date

YYYY

5- Applicant Gender

Male

Female

6- Applicant Mobile Phone

eg: 758-###-####

(###)

###

####

7- Applicant Home Phone

eg: 758-###-####

(###)

###

####

8- Applicant Residence Address

P.O. Box or Community, Town etc

9- Country of Citizenship

10- Program Starting Date

YYYY

11- Present Applicant Marital Status

Select in the list

12- Partner Name

First Name

Last Name

13- Person to Contact in case of Emergency

First Name

Last Name

14- Emergency Contact Address

P.O. Box or Community, Town etc

15- Emergency Contact Mobile Phone

eg: 758-###-####

(###)

###

####

16- Emergency Contact Home Phone

eg: 758-###-####

(###)

###

####

17- Emergency Contact Email

Leave blank if no Email available

18- Do you have Children you are taking care of or coming with you?

Yes

19- Name of the Church you are presently Atending

20- Church affiliation or Denomination

Most church are affiliated to a larger denomination body (such as : Baptist, Evangelical, Pentecostal, etc... if not They are INDEPENDENT

21- Pastor Name

First Name

Last Name

22- Pastor Title

23- Church Address

P.O. Box or Community, Town etc

24- Church Email

Leave blank if no Email available

25- Church Office Phone

758- ###-####

(###)

###

####

26- For How Long have you attend this church

indicate: duration such as 7 months, 4 years, etc...

27- What are some the Ministries you are involve in within or out of the church

eg: worship, children, cef, iccf, other (you can enter multiple ministries)

28- Do you have all the money required for this school/program?

Application fees is EC$ 50 and course fee EC$600 there could be some additional resources fee to consider. a payment plan can be arrange,

Yes

29- Please explain

30- Indicate the levels of Education that you have completed ?

31- Indicate any language that you an speak read or write at least at a Minimum Professional proficiency

32- Please List some of the Skill, Expertise, Talents, Experience or even Gift that you have

Please list anything from practical skill professional expertise to spiritual gift that you know

33- Referee Name

Give us the name and contact of a mature Christian who can answer a few question about you

First Name

Last Name

34- Referee Address

P.O. Box or Community, Town etc

35- Referee Email

36- Referee Mobile Phone

758-###-####

(###)

###

####

37- Referee relationship to You

what is this referee relationship with You: it could be; FRIEND, EMPLOYER, PASTOR, LEADER, etc... a reference form will be send to him or her to complete

38- Do You any medical condition we need to know off? please explain!

- Do you have any health issue that requires special attention? - Do you have any Food or drug Allergy please indicate! - do you have any physical disability we need to know of? - Are you taking a special medication

39- I certify that all information in this application is complete and accurate and If accepted by Youth With A Mission Saint Lucia. I will abide to the best of my abilities by the Spirit, rules and schedule of the program. I confirme that I understand that the payment of the required program fees/tuition must be made before its start and I am fully aware of my obligations before God and to YWAM. *

Yes

40- I commit to solve any offence or misunderstanding occuring during my time at the base in accordance with the biblical principles in Matt 18: 15-17 / Matt 5:23-24 *

Yes

41- Application Completed by *

41- Application Completed by

First Name

Last Name

42- Application Completed on

indicate the date you completed this application

YYYY

Please Submit Application above before proceeding to personal questions

Proceed to Completing personal questions