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									DTS Application Form
YWAM COOK ISLANDS                                             Guide to complement application
All the questions on the forms must be completed. If a question does not apply to you, write N/A in the
space provided. Husbands and wives must complete separate applications. Your checklist:

1. Application Form completed - please use ink or typewriter, not pencil.
2. Registration Fee - A non-refundable Application Fee of $NZD40 – singles $NZD50 - families/couples is
   to be sent with your application. Your application cannot be processed without it.
3. Personal History - Please prayerfully and concisely answer the following questions on a separate
   sheet of paper and attach it to your application form.
   a. Personal History - Please prayerfully and concisely answer the following questions on a separate
        sheet of paper and attach it to your application form.
   b. Describe fully your conversion experience (not more than one page)
   c. Describe your current relationship with the Lord.
   d. Give an outline of your involvement with church and other groups, e.g. WEC, Navigators, Rotary,
        Drama, etc, from your childhood until now.
   e. Describe the relationships within your family.
   f. What are some of your goals/plans/desires for your future?
   g. What plans do you have after the completion of the DTS?
   h. What particular needs do you have in your life that you see the DTS helping to meet?
   i. Do you feel you have a particular ministry? (e.g. worship leading, music, teaching, street evange-
        lism, administration, children’s work, etc.)
   j. Why do you desire to take part in YWAM’s programmes?
   k. List any health or special limitations in the physical, mental or emotional areas which would assist
        us.
   l. What is your Parents and Pastors counsel in regards to undertaking this school?
   m. Are you willing to co-operate with your course leadership during this school?
   n. Are you engaged? If yes, has your fiance applied for or completed the same school?
   o. Married applicants, please comment on any individual hesitations or questions you may have
        about doing this school.
   p. If you are married with a family, please describe your children. Include comments on their physi-
        cal, educational, social and spiritual development.
   q. List the names, addresses and relationship of the people you have requested to submit a confi-
        dential reference on your behalf.
   r. List your particular talents, abilities and skills.
   s. List anything else we should know about you and your situation (e.g. unsympathetic parents,
        broken relationships, past drug/alcohol use)
4. Waiver Clause - please make sure you have signed this clause before giving the reference forms to
   your referees.
5. Reference Forms - One of these forms is to be given to your pastor; one to your employer or teacher;
   and the other to a friend. Please ask them to complete the form and mail it directly to our YWAM
   base. Address is on top of each reference form.
6. Medical Report - Please have this form completed and returned directly to our office. These reports
   must also be submitted for your children.
7. Photographs - two (2) recent photographs of yourself (passport size) should be attached to your ap-
   plication.
8. Language/Aptitude Test - this may be required for some students from non-English speaking coun-
   tries.
9. Education Records - if you intend to enrol for credit in a University of the Nations programme, you
   need to bring Transcripts from any previous study completed.
YWAM COOK ISLANDS                                                                                                          Personal Information


First Name                                Middle Name                                     Family Name/ Surname
                                                                                                                                                       Photo
                                                                                                    Male            Female
Age                    Birthday (Day/Month/Year)        Birthplace (City/State/Country)       Sex



Predominant Ethnic Background: e.g. European, Maori, Samoan, Tongan, Chinese etc:


English:                    Elementary speaking                                             Full professional proficiency
                            Limited word proficiency                                        Native speaking proficiency
                            Minimum professional proficiency                                Mother tongue

Other languages and proficiency:



Current Address until:

Current Address:
                                 Street/ P.O.Box                               City                               Postal Code


                                 Country                                       Phone                              Fax


                                 Email



Permanent Address:
                                 Street/ P.O.Box                               City                               Postal Code


                                 Country                                       Phone                              Fax


                                 Email



Marital Status:            Single               Engaged        Separated                  Divorced            Widowed           Married         Remarried

Spouse’s Name:
                                 First Name                                               Middle Name                           Family Name/ Surname


                                 Age                    Birthday (Day/Month/Year)             Birthplace (City/State/Country)

Dependents:
Family Name/ Surname              First                              Middle                                Birthdate            Sex             School Grade




Will you be accompanied by other dependents? Yes                                       No
YWAM COOK ISLANDS                                                                     Emergency Information

In case of emergency, contact:                                          Relationship:


                                 Street/ P.O.Box          City                  Postal Code


                                 Country                  Phone                 Fax


                                 Email



Home Church:                     Pastor’s Name:


                                 Street/ P.O.Box          City                  Postal Code


                                 Country                  Phone                 Fax


                                 Email




 Weight:          kg                     Height:          cm                  Blood Type:
                  st       lbs                            ft      ins         0/ A/ B/ AB (+ or -)


 Are you allergic to any drugs? No            Yes    (specify)

 Comments:




YWAM COOK ISLANDS                                                                         General Information
What occupational work experience or profession, skills or qualifications do you have?



Educational Background, courses complete etc.?



Do you play any instruments?     Yes          (specify)   No


Other talents?



Do you have any medical history or current condition which others need to be aware of?
YWAM COOK ISLANDS                                                                                                                 Finances

What percentage of the Lecture Phase do you presently have?


What percentage of the Outreach Phase do you presently have?


What plans or resources do you have to meet outstanding fees?


Do you have any current debts?         Yes              No
If yes, what are your plans to pay these off?




YWAM COOK ISLANDS                                                                            Passport / Visa / Insurance

Full Name as written in Passport:
                                       First Name                            Middle Name                           Family Name/ Surname



Passport:
                                       Issue City                            Issue Country


                                       Number                                Expiration Date (Day/ Month/ Year)

Country of Citizenship:

Visa:
                                       Type (Non-Australian students only)   Date of Issued (Day/ Month/ Year)


                                       City and Country Visa issued          Visa expiry date (Day/ Month/ Year)




Visa Info General
You need a valid Passport to enter the Cook Islands. No Identity Papers e.t.c. accepted.
Overseas volunteers for visits less then 30 days, no visa is required. For stays longer then 30 days, a for-
mal application will need to be submitted to local immigration prior to arrival. Please find attached a med-
ical and Police Clearance needed. There will be a fee of NZ$80 for a 6 months visa and a return ticket is a
must. You will normally be required to show you can support yourself while in the Cook Islands. Please do
not hesitate to contact us if you require more information.

Insurance
We insist that you have personal healthcare cover while staying in the Cook Islands.
YWAM COOK ISLANDS                                                   Statements of Consent, Liability Release
                                                                                     and Consent for Burial


YWAM COOK ISLANDS                                                                         Consent for Treatment
“Should a situation arise where I am sick or injured and urgently require medical attention, I give to the
Base Director, or his/ her delegate the authority to make any decision concerning my immediate treat-
ment, including anaesthetics, medication and operations as in the opinion of the attending physician are
deemed necessary or until as such time I am able to make decisions for myself.
I declare that the above named shall not be required to contact my next of kin prior to excercising his/
her authority as provided herein.

I declare that I shall not hold Youth With A Mission, Cook Islands, the Base Director or his/ her delegate,
liable for any decision made by him/ her for any damage or loss that I sustain as a result of excercising
the authority herein granted by me.”

Applicants Full Name:

Applicants Signature: ______________________________________                           Date 4-Jul-12
or Parents Signature ______________________________________                            Date 4-Jul-12
or responsible party if applicant under the age of 18




YWAM COOK ISLANDS                                                                                 Liability Release
“I release Youth With A Mission, Cook Islands, it’s agents, employees and volunteer assistants from any
liability whatsoever arising out of injury, damage or loss which be sustained by myself during the course
of my involvement with Youth With A Mission, Cook Islands.”

Applicants Full Name:

Applicants Signature: ______________________________________                           Date 4-Jul-12
or Parents Signature ______________________________________                            Date 4-Jul-12
or responsible party if applicant under the age of 18




YWAM COOK ISLANDS                                                                                Burial Statement
“In case of my death during the course of my involvement with Youth With A Mission, Cook Islands,
I wish that my next of kin be advised as soon as practical and that their wishes with regard to funeral and
disposal of my body be complied with so long as my next of kin places Youth With A Mission, Cook Is-
lands in sufficient funds to carry out those wishes. In the case where Youth With A Mission, Cook Islands
is unable to contact my next of kin or that my next of kin are unable or unwilling to give directions as to
funeral and disposal of my body and come to a satisfactory arrangement with regard to payment of relat-
ed costs within reasonable time, then I direct that Youth With A Mission, Cook Islands at its sole discre-
tion make arrangements for funeral and disposal (including burial in a foreign country) at the expense of
my estate.”

Applicants Full Name:

Applicants Signature: ______________________________________                           Date 4-Jul-12
or Parents Signature ______________________________________                            Date 4-Jul-12
or responsible party if applicant under the age of 18



Please mail this confidential form to:                  Youth With A Mission
                                                        Discipleship Training School
                                                        P.O.Box 436                      E-mail: seeyou@ywamcooks.com
                                                        Rarotonga, Cook Islands          http://www.ywamcooks.com
YWAM COOK ISLANDS                                             Acknowledgement of financial responsibility
I understand that the payment of the required school fees must be made on the commencement day of
the school, unless otherwise approved in writing by the School Director before my departure for the
School.

I further understand that if, for any reason, I should withdraw from the School up until 7 days after the
commencement, I will receive a full refund less 10% or $500, whichever is the lesser.

I agree to meet in a timely manner, prior to the completion of the school, all personal expenses incurred
during my involvement with Youth With A Mission.

If I am accepted by Youth With A Mission, I will abide by the spirit, rules and schedule of this course.

Applicants Signature: ______________________________________                           Date 4-Jul-12
or Parents Signature ______________________________________                            Date 4-Jul-12
or responsible party if applicant under the age of 18




YWAM COOK ISLANDS                                                                             For our information

How did you first hear of Youth With A Mission?


How did you first hear of The Cook Islands Base?


What reasons most influenced your decision to apply here to The Cook Islands?


I certify that all information in this application is complete and accurate.


Applicants Signature: ______________________________________                           Date 4-Jul-12
or Parents Signature ______________________________________                            Date 4-Jul-12
or responsible party if applicant under the age of 18



Youth With A Mission admits students of any race, colour, national and ethnic origin to all the rights, privi-
leges, programmes and activities generally accorded or made available to students at the school.

Please mail this confidential form to:                  Youth With A Mission
                                                        Discipleship Training School
                                                        P.O.Box 436                      E-mail: seeyou@ywamcooks.com
                                                        Rarotonga, Cook Islands          http://www.ywamcooks.com
YWAM COOK ISLANDS                                                                                   Medical Report
TO THE APPLICANT: Please complete the information and waiver below.
Provide a stamped envelope addressed to the Registrar for the person completing this reference.

Name of Applicant:
                            First Name                        Middle Name                         Family Name/ Surname

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

Applicant:                                             Signature:                                            4-Jul-12

The above applicant has applied for admission to Youth With A Mission Cook Islands. Y.W.A.M. is a mis-
sion-oriented, international, interdenominational Christian missionary organization.

We would appreciate you filling out this form to assist us in assessing the above named applicant suitabil-
ity. This is a short term missionary service in which there will be some physical exertion over a period of
24 weeks of training and study in a group situation with possible overseas travel. This form will be kept
confidential. Serious consideration will be given to your comments; therefore we ask that you complete
this form carefully. Thank you for your assistance. Please indicate the following, and comment where
necessary:

1.    Weight         kg (             st   lbs)        Height               cm (           ft         ins)

2.    Is the applicant under medical supervision at this time or taking any medication?

      If so, what kind?

3.    Would you consider the applicant in good physical health?          Yes             No

4.    Is the applicant’s chest, heart and blood pressure normal?         Yes             No

5.    Is the applicant’s sight, hearing and speech normal?               Yes             No

6.    Has the applicant adequate emotional and mental stability to undertake such service and training?
      Yes       No

7.    Please list any significant medical and/or psychiatric history:


8.    Please add any additional comments regarding the applicant’s health or special limitations affecting
      physical, mental or emotional capabilities




Doctors Sign:                                                                          4-Jul-12


Doctors Name                 Street                          Country, Zip Code, City



Please mail this confidential form to:       Youth With A Mission
                                             Discipleship Training School
                                             P.O.Box 436                                E-mail: seeyou@ywamcooks.com
                                             Rarotonga, Cook Islands                    http://www.ywamcooks.com
YWAM COOK ISLANDS                                                                     Reference Form - Friend
TO THE APPLICANT: Please complete the information and waiver below.
Provide a stamped envelope addressed to the Registrar for the person completing the reference.

Name of Applicant:
                           First Name                         Middle Name                    Family Name/ Surname



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

Applicant:                                            Signature:                                       4-Jul-12

The above applicant has applied for admission to Youth With A Mission Cook Islands. Y.W.A.M. is a mis-
sion-oriented, international, interdenominational Christian missionary organization.

We would appreciate you filling out this form to assist us in assessing the above named applicant suitabil-
ity. This is a short term missionary service in which there will be some physical exertion over a period of
24 weeks of training and study in a group situation with possible overseas travel. This form will be kept
confidential. Serious consideration will be given to your comments; therefore we ask that you complete
this form carefully. Thank you for your assistance. Please indicate the following, and comment where
necessary:

How well do you know the applicant?                  Very Well                Well            Casually

What is your relationship to the applicant?          Employer                 Teacher         Friend

                                                           Above                          Below
                                        Superior           Average          Average       Average        Inferior
 Initiative
 Social Adaptability
 Concern for others
 Ability to Follow
 Leadership
 Judgement/ Decision Making
 Emotional Stability
 Health
 Personal Appearance

Comments:


Mental Ability                    quick to comprehend            average                      slow
Industry                          hardworker                     average                      lacks persistence
Reliability                       meets obligations              average                      neglects obligations
Cooperation                       works well with others         average                      experiences difficulty
Flexibility                       open to change                 average                      unyielding
Christian Character               well balanced                  average                      unstable
Disposition                       cheerful                       average                      passive
Punctuality                       punctual                       average                      often late
Financial Responsibility          honours obligations            average                      neglectful

Comments:
1. Does he/she display high moral standards?               Yes              No (please explain)


2. Is he/ she prejudiced against any groups, races or nationalities? Yes (please explain)                         No


3. In your consideration, which of the following would best describe the applicant’s Christian experience?
       Mature                    Genuine and growing         Over-emotional         Superficial


4. Overall, what do you consider to be the applicant’s strong points (include Special Abilities)?



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



6. In your opinion, what are the applicant’s motives for applying to YWAM Cook Islands?



7. Please add any relevant remarks:



8. Do you see the applicant as having potential for missionary service with YWAM Cook Islands?
      Yes           with some Reservation (please explain)               No (please explain)




I have known the applicant for            years or months


Friends Sign:                                                                           4-Jul-12


First Name                 Family Name/ Surname                  Position                         Email Address



Would you like to receive further information about YWAM Cook Islands?                    Yes            No

YWAM Cook Islands admits staff or mission builders of any race, color, national and ethnic origin to the
rights, privileges, programs and activities generally accorded or made available at our center.

Please mail this confidential form to:            Youth With A Mission
                                                  Discipleship Training School
                                                  P.O.Box 436                           E-mail: seeyou@ywamcooks.com
                                                  Rarotonga, Cook Islands               http://www.ywamcooks.com
YWAM COOK ISLANDS                                                             Reference Form - Employer
TO THE APPLICANT: Please complete the information and waiver below.
Provide a stamped envelope addressed to the Registrar for the person completing the reference.

Name of Applicant:
                           First Name                         Middle Name                  Family Name/ Surname



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

Applicant:                                            Signature:                                     4-Jul-12

The above applicant has applied for admission to Youth With A Mission Cook Islands. Y.W.A.M. is a mis-
sion-oriented, international, interdenominational Christian missionary organization.

We would appreciate you filling out this form to assist us in assessing the above named applicant suitabil-
ity. This is a short term missionary service in which there will be some physical exertion over a period of
24 weeks of training and study in a group situation with possible overseas travel. This form will be kept
confidential. Serious consideration will be given to your comments; therefore we ask that you complete
this form carefully. Thank you for your assistance. Please indicate the following, and comment where
necessary:

How well do you know the applicant?                  Very Well                Well          Casually

What is your relationship to the applicant?          Employer                 Teacher       Friend

                                                           Above                        Below
                                        Superior           Average          Average     Average        Inferior
 Initiative
 Social Adaptability
 Concern for others
 Ability to Follow
 Leadership
 Judgement/ Decision Making
 Emotional Stability
 Health
 Personal Appearance

Comments:


Mental Ability                    quick to comprehend            average                    slow
Industry                          hardworker                     average                    lacks persistence
Reliability                       meets obligations              average                    neglects obligations
Cooperation                       works well with others         average                    experiences difficulty
Flexibility                       open to change                 average                    unyielding
Christian Character               well balanced                  average                    unstable
Disposition                       cheerful                       average                    passive
Punctuality                       punctual                       average                    often late
Financial Responsibility          honours obligations            average                    neglectful

Comments:
9. Does he/she display high moral standards?               Yes              No (please explain)


10. Is he/ she prejudiced against any groups, races or nationalities? Yes (please explain)                        No


11. In your consideration, which of the following would best describe the applicant’s Christian experience?
        Mature                    Genuine and growing         Over-emotional         Superficial


12. Overall, what do you consider to be the applicant’s strong points (include Special Abilities)?



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



14. In your opinion, what are the applicant’s motives for applying to YWAM Cook Islands?



15. Please add any relevant remarks:



16. Do you see the applicant as having potential for missionary service with YWAM Cook Islands?
       Yes           with some Reservation (please explain)               No (please explain)




I have known the applicant for            years or months


Employer Sign:                                                                            4-Jul-12


First Name                 Family Name/ Surname                  Position                         Email Address



Would you like to receive further information about YWAM Cook Islands?                    Yes            No

YWAM Cook Islands admits staff or mission builders of any race, color, national and ethnic origin to the
rights, privileges, programs and activities generally accorded or made available at our center.

Please mail this confidential form to:            Youth With A Mission
                                                  Discipleship Training School
                                                  P.O.Box 436                           E-mail: seeyou@ywamcooks.com
                                                  Rarotonga, Cook Islands               http://www.ywamcooks.com
YWAM COOK ISLANDS                                                                 Reference Form - Pastor
TO THE APPLICANT: Please complete the information and waiver below.
Provide a stamped envelope addressed to the Registrar for the person completing the reference.

Name of Applicant:
                           First Name                         Middle Name                Family Name/ Surname



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

Applicant:                                            Signature:                                   4-Jul-12

The above applicant has applied for admission to Youth With A Mission Cook Islands. Y.W.A.M. is a mis-
sion-oriented, international, interdenominational Christian missionary organization.

We would appreciate you filling out this form to assist us in assessing the above named applicant suitabil-
ity. This is a short term missionary service in which there will be some physical exertion over a period of
24 weeks of training and study in a group situation with possible overseas travel. This form will be kept
confidential. Serious consideration will be given to your comments; therefore we ask that you complete
this form carefully. Thank you for your assistance. Please indicate the following, and comment where
necessary:

How well do you know the applicant?                  Very Well                Well        Casually

                                                           Above                      Below
                                        Superior           Average          Average   Average        Inferior
 Initiative
 Social Adaptability
 Concern for others
 Ability to Follow
 Leadership
 Judgement/ Decision Making
 Emotional Stability
 Health
 Personal Appearance

Comments:


Mental Ability                    quick to comprehend            average                  slow
Industry                          hardworker                     average                  lacks persistence
Reliability                       meets obligations              average                  neglects obligations
Cooperation                       works well with others         average                  experiences difficulty
Flexibility                       open to change                 average                  unyielding
Christian Character               well balanced                  average                  unstable
Disposition                       cheerful                       average                  passive
Punctuality                       punctual                       average                  often late
Financial Responsibility          honours obligations            average                  neglectful

Comments:
1. To what extent is the applicant active in church work?


2. With respect to his/ her christian service, do you consider the applicant to be:
      Dedicated              Average               Casual         Please explain:


3. In your consideration, which of the following would best describe the applicant’s Christian experience?
       Mature                        Genuine and growing           Over-emotional           Superficial

4. How does the applicant usually react in trying situations?
     Withdraws     Gets Discouraged        Gets Angry      Meets Constructively       Accepts Patiently
     Other (explain)



5. Please circle the words or descriptions which pertain to the applicant:
       Impatient     intolerant     argumentative       domineering    critical of others   easily embar-
   rassed     easily offended      discouraged      frequently worried    anxious      nervous or tense
   given to moods       prejudiced towards groups/races/nationalities      addictive behavior       unable
   to cope with stress     erratic in attitudes or actions
   If necessary, please elaborate on a separate sheet of paper!

6. In your consideration, which of the following would best describe the applicant’s Christian experience?
       Mature                         Genuine and growing            Over-emotional            Superficial


7. Overall, what do you consider to be the applicant’s strong points (include Special Abilities)?



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



9. Has the applicant proven on any occasion to be unreliable, dishonest, or of questionable character?
      Yes (please explain)        No



10. Please add any other relevant remarks concerning medical, psychological, drug/ alcohol use or other
    areas of their life we should know more about to be of service to them:
11. Do you see the applicant as having potential for missionary service with YWAM Cook Islands?
       Yes           with some Reservation (please explain)               No (please explain)




12. Is your congregation aware of and standing behind the applicant in his/ her involvement with YWAM?
                Yes        No

13. As a pastor, if you feel it is right for the applicant to participate in this pioneering ministry, would you
    offer any pastoral counsel to us helping him/ her adjust to a foreign country and new situation?
    Yes         No

I have known the applicant for             years or months


Pastors Sign:                                                                     4-Jul-12


First Name                  Family Name/ Surname                  Position



Would you like to receive further information about YWAM Cook Islands?              Yes      No
Email : __________________________

YWAM Cook Islands admits staff or mission builders of any race, color, national and ethnic origin to the
rights, privileges, programs and activities generally accorded or made available at our center.

Please mail this confidential form to:             Youth With A Mission
                                                   Discipleship Training School
                                                   P.O.Box 436                    E-mail: seeyou@ywamcooks.com
                                                   Rarotonga, Cook Islands        http://www.ywamcooks.com

								
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