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GUIDE TO COMPLETING SCHOOL APPLICATION

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					                  YWAM Heredia                                       “Knowing God and caring for His Creation”



                            GUIDE TO COMPLETING DTS APPLICATION


Thank you for applying for training with YWAM Heredia, Costa Rica. May you know the Lord’s grace as you seek His
direction. In order for us to process your application, we must receive all the following completed forms. If a question
does not apply to you, write N/A in the blank. Husbands and wives enrolling as students must complete separate
applications.


1. Main Application Form (HA 1-5). This form must be filled out for any DTS that you wish to apply for at the
   Youth With A Mission Heredia base in Costa Rica.


2. Application Fee. A non-refundable application fee of US $40 for singles and US $60 for a couple is to be sent in
   with your application. ALL CHECKS ARE TO BE FROM A US BANK AND IN US DOLLARS. Your application
   cannot be processed until the application fee is received.


3. Personal History. Please prayerfully and concisely answer the following questions on a separate sheet of paper
   (print or type) and attach it to the application form: Page HA-6. Your answers will be significant in the application
   process.

    a)    Please describe your conversion experience and present spiritual relationship with the Lord. (Not more than
          one page.)

     b)   What areas of your character are you presently seeking God to further develop and improve?

     c)   How do you see God’s call on your life? Do you feel God is leading you into any particular area?

    d)    Do you have any present counseling needs?

     e)   How would you describe your relationship with your parents/family?

     f)   How do your parents/family feel about your plans to enroll for training with YWAM – Heredia, Costa Rica?

     g)   Do you have a calling or an attraction to any part of the world?

     h)   Does your Pastor know of your calling? Are they sending you out with their blessing?

     i)   One of our goals is to release people into ministry. Would you be willing to go into ministry?


4. Health Form (HCHF 1-4) Please complete this form and return it directly to the YWAM-Heredia base in
   Costa Rica. These forms must also be submitted for any children who will accompany you.

5. Reference Forms: On each of the three reference forms enclosed write in your course and date, include your email
   address and phone number, and then sign it. Give one form to your pastor, one to your employer and one to a friend.
   Ask all your references to complete the form and mail it directly to the YWAM-Heredia base in Costa Rica. Please
   list their names on a separate piece of paper and attach this list to your application. We must receive all 3 of these
   reference forms BEFORE we can process your application.




PLEASE DIRECT           JuCUM – HEREDIA *         APARTADO 1444-3000            *  HEREDIA, COSTA RICA
ALL FORMS TO:              506/267-7063 *         FAX: 506/267-7063 *           EMAIL: YWAMCR@RACSA.CO.CR                  1
                    YWAM Heredia                                                 “Knowing God and caring for His Creation”



                                                           APPLICATION FOR DISCIPLESHIP TRAINING SCHOOL
Date of Application (DD/MM/YY)                                               _

Registration fee of $40 US currency enclosed?      Yes                                                                 IMPORTANT
DTS Applying for:                                                                                       _
                                                                                                                       PLEASE ATTACH
(DTS is a prerequisite for being on staff and for any other YWAM schools)
                                                                                                                       RECENT PHOTO
Starting Date (MM/YY)                           Second Choice (MM/YY)                                   _                  HERE


PERSONAL INFORMATION

Last/Family Name:                                          First:                                                      Middle:                    _

Current Address:                                                                                                                                  _

City:                                                 State/Province:                           Postal/Zip Code:                                  _

Country:                                                            This Address Good Until: (DD/MM/YY                                            _

Permanent Address:                                                                                                                                _

City:                                                 State/Province:                           Postal/Zip Code:                                  _

Country                                                             _

Phone Number 1                                                          _ Fax:                                                                    _

Phone Number 2: ______________________                    __________Email: ________             __________         ______________________

Date of Birth: (DD/MM/YY) ____           ______       ___________ Age: __              ___Birthplace: _ _________ ___________________

Sex:    MF    US Social Security Number: ____________              _________                              _

FAMILY INFORMATION
Marital Status
■ Single ■  Engaged (Date _____           ____) ■ Married (Date ____              ______) ■ Separated (Date ____                  ____)
            Divorced (Date _____         ____) ■  Remarried (Date ___               _____) ■ Widowed (Date ___                   _____)

Spouse’s Information
  Last Name: ____________           ___________________ ___ First: __ ____                    _________________ Middle:_____________

 Date of Birth: (DD/MM/YY) ____________           __________ Age: ____________ Birthplace:__                                 ________________

Dependent Children Accompanying You

Name: ____________       ______________________ Date of Birth: (DD/MM/YY) ____ _                    _______ Age:                 Sex: MF

Name: ____________       ______________________ Date of Birth: (DD/MM/YY) ____ _                    _______ Age:                 Sex: M F

Name: ____________       ______________________ Date of Birth: (DD/MM/YY) ____ _                    _______ Age:                 Sex: M F

Name: ____________       ______________________ Date of Birth: (DD/MM/YY) ____ _                    _______ Age:                 Sex: M F

Name: ____________       ______________________ Date of Birth: (DD/MM/YY) ____ _                    _______ Age:                 Sex: M F
Will you be accompanied by other dependents?      No Yes          If Yes please indicate below:
Name: ____________       ______________________ Date of Birth: (DD/MM/YY)                                       Age:             Sex: M F
                                                                                                                                         HA –1

PLEASE DIRECT             JuCUM – HEREDIA *               APARTADO 1444-3000                *  HEREDIA, COSTA RICA
ALL FORMS TO:                506/267-7063 *               FAX: 506/267-7063 *               EMAIL: YWAMCR@RACSA.CO.CR                         2
                  YWAM Heredia                                                  “Knowing God and caring for His Creation”



PASSPORT/ VISA INFORMATION  I do not have a valid passport.                             I applied for a passport on                  (date.)

Name as Listed on Passport ___        ______          ___________________________________________________________________

Country/Countries of Citizenship                                                                                                                _

Birthplace: (City) __________                   __________ (State/Prov) _____ ______ (Country) ______              _____________________

City and Country Where Passport Was Issued___________________________                   _________________________________________

Passport # _                                     ___Passport Expiry Date (day)             (month)        (year)       Visa Type               _
(Non-U.S. students only)

Date Visa Issued (day)          (month)          (year)               Visa Expiry Date (day)           (month)         (year)         _

City and Country Where Visa Issued                                                                                                              _

Have you ever been refused a visa?    No  Yes       (Give nation and details)                                                                 _



EMERGENCY INFORMATION

IN CASE OF EMERGENCY, CONTACT: Full Name:_                   _______________ _______________               Relationship:    _ _______ ___ _

PO Box /Street Address:                                                                                                                            _

City: ______________________       _____________________State/Province: ___________ Postal/Zip Code: ___ ________________

Country: _______ _____ ____               __ Phone:               -                             Fax:               -                               _

Office:             -                        Email:                                                                                                _

HOME CHURCH: Name:                                                                     Pastor’s Name:                                              _

Denomination:                                                                                                                                      _

PO Box /Street Address:                                                                                                                            _

City:                                                       State/Province:                     Postal/Zip Code:                                   _

Country:                                      Phone:              -                             Fax:               -                               _

STUDENT EMERGENCY INFORMATION: Height                                        Weight            Blood Type:             O, A, B, AB (+ or -)

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


EXPECTATIONS

How did you first hear of YWAM Heredia?                                                                                                            _

What reasons most influence your decision to apply                                                                                                 _

What expectations do you have for this course?                                                                                                     _

_                                                                                                                                                  _

_                                                                                                                                                  _



                                                                                                                                          HA-2

PLEASE DIRECT              JuCUM – HEREDIA *              APARTADO 1444-3000               *  HEREDIA, COSTA RICA
ALL FORMS TO:                 506/267-7063 *              FAX: 506/267-7063 *              EMAIL: YWAMCR@RACSA.CO.CR                       3
                   YWAM Heredia                                             “Knowing God and caring for His Creation”


EDUCATIONAL INFORMATION
 I have not completed high school/secondary school.Highest educational level completed:_          __________
   High School/Secondary School/College/University/Seminary Attended:

 Name: ____________________________             __________________      _    City:     ______________________ _ _______              _

 Dates Attended: ___________________ ________ Degree/Major/Degree Date: ___ ____________________________ ________

Name:_      _____________________________           ____________________ City:_______ ______________________ _ ______            __

 Dates Attended: ___________________ ________ Degree/Major/Degree Date: ___ ____________________________ ________

Name: ________________________________             ____________________ City:           _ ______________________ _ ___ ___       __

 Dates Attended:_________________ _______              Degree/Major/Degree Date: ____________________________ _______             _

NOTE: If you intend to pursue a U of N degree, transcript(s) of your record(s) at each High School /Secondary School or
College/University /Seminary you have attended must be submitted to the U of N Registrar by the institution.


PAST EMPLOYMENT HISTORY (Please list most recent jobs first)
                                                                                         Dates:                                  _

                                                                                         Dates:                                  _


                                                                                         Dates:                                  _


                                                                                         Dates:                                  _

                                                                                         Dates:                                   _


WORK EXPERIENCE

Current Occupation:                                                                  Work Phone:

Previous Wk Position:                                          Organization/Company:

Dates:                              Location:                                    Supervisor:

Current Occupation:                                                                  Work Phone:

Previous Wk Position:                                          Organization/Company:

Dates:                              Location:                                    Supervisor:

Current Occupation:                                                                  Work Phone:

Previous Wk Position:                                          Organization/Company:

Dates:                              Location:                                    Supervisor:



LANGUAGES
English Proficiency (please indicate proficiency using the number scale below)           _
         1. Elementary Speaking               2. Limited Word Proficiency        3. Minimum Professional Proficiency
         4. Full Professional Proficiency     5. Native Speaking Proficiency     6. Mother Tongue

Other Languages and Proficiency                                                                                                  _

                                                                                                                             HA-3

PLEASE DIRECT             JuCUM – HEREDIA *           APARTADO 1444-3000                *  HEREDIA, COSTA RICA
ALL FORMS TO:                506/267-7063 *           FAX: 506/267-7063 *               EMAIL: YWAMCR@RACSA.CO.CR            4
                YWAM Heredia                                 “Knowing God and caring for His Creation”




SKILLS AND ABILITIES

Skill Levels: (Leave blank if you have no experience in a category)

       1.   A little experience but would need constant supervision.
       2.   Some experience but would still need considerable supervision.
       3.   Considerable experience but would need help with tougher problems.
       4.   Extensive experience; can handle difficulties; can train others.
       5.   Professional training and experience.

____Heavy Equipment Operator                ____Electrical                       ____Cooking
____Auto Repair                             ____Accounting                       ____Receptionist
____Landscaping/Gardens                     ____First Aid/Medical                ____Painting
____Cleaning                                ____Plumbing                         ____Graphics
____Child Care                              ____Heating Repair                   ____Food Service
____Bookkeeping                             ____Typing (WPM_ __)                 ____Desktop Publishing
____Phone Operator                          ____Data Entry                       ____Illustration
____Computer Programming                    ____Sound Equipment                  ____Carpentry
____Baking                                  ____IT skills                            Farm Animals


Would you be willing to get up early and prepare breakfast with a smile__            ___?
Do you play any musical instruments?                If yes, what?
With what type of work do you feel most confident?
Explain any difficulty you may have with any particular job:

Is there anything else you would like to share with us about yourself? (Other talents/special giftings)?




PREDOMINANT ETHNIC BACKGROUND

Predominant Ethnic Background of Student – This information is used for statistical purposes only and will not
be used to determine eligibility for admission. The federal government requires that we supply ethnic
enrollment data. Please circle below.

   Asian or Pacific Islander    White/North American        Hispanic        N. American Indian
   White  Black          Other: Please specify ethnic background:

                                                                                                           HA-4


PLEASE DIRECT        JuCUM – HEREDIA *       APARTADO 1444-3000        *  HEREDIA, COSTA RICA
ALL FORMS TO:           506/267-7063 *       FAX: 506/267-7063 *       EMAIL: YWAMCR@RACSA.CO.CR           5
                   YWAM Heredia                                              “Knowing God and caring for His Creation”


CONSENT FOR TREATMENT

In case of emergency, I/we hereby agree to the performance of such treatment, including anesthesia and surgery, as the
attending doctor or physician may deem necessary.

Applicant’s Signature:                                                                         Date:                                      _
Signature of parent or guardian required if applicant is less than 18 years of age:

Signature:                                                       Date:                       Relationship:                                _




FINANCIAL INFORMATION

Do you have your complete school fees?           Yes  No
If No, how much do you have at this time? $                     From what source will they come?                                          _

Do you have any outstanding debt? (If so, please explain):                                                                                _

ACKNOWLEDGEMENT OF FINANCIAL RESPONSIBILITY: I understand that payments of the required school tuition
fees must be made in U.S. currency prior to or upon arrival, unless otherwise approved in writing by the School Director
before my departure for Heredia, Costa Rica. Further, I agree to meet in a timely manner, prior to the completion of
school, all personal expenses incurred during my involvement with Youth With A Mission Heredia and University of the
Nations. If I am accepted by YWAM Heredia, I will abide by the Spirit, rules, and schedule of the base.

Signature:                                                                Date:                                    _
”Lord, who may dwell in your sanctuary? Who may live in your holy hill? He…who keeps his oath even when it hurts…”
                                                   (Psalm 15:1, 4b)



RELEASE OF LIABILITY

I/We do hereby release University of the Nations, and Youth With A Mission Heredia, its staff, agents, and volunteer
assistants from any liability whatsoever arising out of any injury, damage, or loss which may be sustained by said
person(s) during the course of involvement with University of the Nations.

Applicant’s Signature:                                                                           Date:                                    _
Signature of parent or guardian required if applicant is less than 18 years of age:

Signature:                                                   Date:                           Relationship:                                _
I certify that all information in this application is complete and accurate.

Applicant’s Signature:                                                                           Date:                                    _



UNIVERSITY OF THE NATIONS IS A DEGREE GRANTING INSTITUTION (Associate, Bachelor, & Master), BUT IS NOT
ACCREDITED BY ANY ACCREDITING AGENCY OR ASSOCIATION RECOGNIZED BY THE UNITED STATES COMMISSIONER OF
EDUCATION.

University of the Nations (U of N) admits students of any race, color, national, and ethnic origin to all rights, privileges, programs, and
activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national,
and ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other
school-administered programs.


                                                                                                                                      HA-5

PLEASE DIRECT              JuCUM – HEREDIA *            APARTADO 1444-3000              *  HEREDIA, COSTA RICA
ALL FORMS TO:                 506/267-7063 *            FAX: 506/267-7063 *             EMAIL: YWAMCR@RACSA.CO.CR                     6
                   YWAM Heredia                                                 “Knowing God and caring for His Creation”


                                                                                       CONFIDENTIAL HEALTH FORM

TO THE APPLICANT: THIS INFORMATION IS TREATED AS CONFIDENTIAL AND SEPARATE FROM YOUR ACADEMIC RECORDS
Please print or type answers to ALL questions IN ENGLISH. As certain medical conditions may preclude acceptance, Part B must be
completed by your physician or physician’s assistant. Less inclusive medicals done for other YWAM bases are not acceptable.
SCHOOL YOU ARE APPLYING FOR: _____________                 ______________ STARTING DATE: _____ _                       _________
Last/Family Name: ______________________________ First: _______________                     ___________ Middle: ________           _____ ___

Permanent Address: ______________________ _______________________________ Phone: _______________________
Present Address: ________________________________________________________ Phone: _______________________
Date of Birth: (DD/MM/YY) ________________________ Age: __________ Birthplace: _______________________________
US Social Security Number: _______________________________ Citizen of: ______________________________________
PERSON TO BE NOTIFIED IN CASE OF EMERGENCY: (Last / First) ______________________________                                      ______ ____
Address: ________________________________________________________________________________ _______ ___
Relationship: ___________________ Home Phone: ____________________ Phone 2 (if available): __________________ ___
NEXT OF KIN: (Last / First) _______________________              _________________________________________________ ___
Address: ___________________________________________________________________________________ _____ __
Relationship: ________     ___________ Home Phone: _________          ___________ Phone 2 (if available): ______           ___________ _ _____

Do you have medical insurance?  No  Yes Name of Insurer ____________________         __________ Med. Ins. No. ______                ______

Med. Insurance coverage (briefly): ________________________                             ____________________________________________________


PART A: PERSONAL HISTORY
Please answer all questions and take both Part A and Part B to your physician. Comment on all positive answers on a separate sheet of
paper. The omission of health history problems or incomplete explanation of the same can lead to removal of acceptance status.
Have you ever had, or do you now have, any of the following:
                          NO YES                              NO YES             Have you ever had any of the following?
Skin Condition ■            ■ Low Blood pressure ■                            COMMUNICABLE DISEASES?
Eye Trouble ■               ■ Allergy: Bee Stings* ■                                                            NO YES
Ear Trouble ■                 ■    Allergy: Penicillin ■                            Chicken Pox                           
Head Injury ■                 ■    Allergy: Sulfonamides ■                          Measles (Rubella)                     
Recurrent Headaches ■         ■    Allergy: Serum ■                                 Measles (Rubeola)                     
Epilepsy ■                    ■    Allergy: Food (specify) ■                        Mumps                                 
Fainting Spells ■             ■    Tumor/Cancer ■                                   Pertussis                             
Weakness ■                    ■    Rheumatism/Arthritis ■                           Scarlet Fever                         
Paralysis ■                   ■    Back Problems ■                                  Tuberculosis                          
Insomnia ■                    ■    Dislocation of Joints ■                          OTHER (specify)________                 ___________
Shortness of Breath           ■    Broken Bones ■                  
Hay fever ■                   ■    Stomach/Duodenal Ulcer ■                         FEMALES ONLY:
Asthma ■                      ■    Gall Bladder Problems ■                          Irregular Periods                     
Hepatitis                     ■    Jaundice ■                                       Severe Cramps                         
Recurrent Diarrhea            ■    Intestinal Troubles ■                            Excessive Flow                        
Kidney Disease ■              ■    Diabetes ■                                       Are you pregnant?                     
Venereal Disease ■            ■    Anemia ■                                         Previous pregnancies                  
High Blood Pressure ■         ■    Heart Trouble                   ■
Mental/Nervous Disorders      ■    *If you are allergic to bee stings, you must bring your own up-to-date reaction kit

                                                                                                                                     HCHF - 1

PLEASE DIRECT              JuCUM – HEREDIA *             APARTADO 1444-3000                  *  HEREDIA, COSTA RICA
ALL FORMS TO:                 506/267-7063 *             FAX: 506/267-7063 *                 EMAIL: YWAMCR@RACSA.CO.CR                   7
                    YWAM Heredia                                                  “Knowing God and caring for His Creation”


Other illnesses or conditions: ____________                            ___________________        _________________________________________

_____________________________________________________________________________________ _________                                          ______

Are you at present under a doctor’s care for any condition? No Yes Specify: ________                  _              _______________________

____________________________________________________                                                                                    _______

Are you taking any medication at this time? No  Yes Specify: ______ _______ ________________                          ______________________

___________________             __________________             PLEASE ARRANGE TO BRING ALL NECESSARY LONG-TERM MEDICATIONS WITH YOU
Are you allergic to any drugs? No  Yes Specify: ________            _________           ______________________________________         ______

_______________________________________________________                                   ___________________________________ ___________

Do you have a history of emotional instability or psychiatric treatment? No Yes If “Yes”, when: ______                                  _____

 _______                                   ____ For how long: _______                            ________________   Still in treatment? No Yes

Please explain __________________________________________________________________________________                                      ______

Do you have any history with: Eating disorders? No Yes Drug or alcohol abuse? No Yes Sexual issues? No Yes
If “Yes” to any above, when: _____            ______________ For how long: ___   ____      ___________ Currently?  No Yes


Please explain ________________________                                     ________________________________________________________________


Do you now or have you ever received any compensation for disability from any source? ■No Yes Specify:                                        _

______________ ____________________                                      ___________________________________________________________________

Do you have any physical impairments, handicaps, or health conditions which require special attention? No  Yes Specify: ___               ____

___________________________________________________________________________                                           __________________________
Have you been tested for HIV? No  Yes If “Yes”, what were the results? Neg Pos
Your response to the above questions will not necessarily determine admission considerations .

SURGERIES PERFORMED:
   Date (month/year) _________                    ___Type    of Surgery ________________                ___________________________________

     Outcome and long-term effects_________________________                                      ____ ______________________________________

   Date (month/year) _______                 ________Type    of Surgery _       _______________             __________________________________

     Outcome and long-term effects _______________                                 ____________________________________________________

Please rate your health: ■ Excellent  Good                 Fair ■  Poor
Do you wear contact lenses or glasses?            No  Yes Specify: ________________                           _________________________

FAMILY HISTORY:
Have any of your relatives ever had any of the following? No Yes                      Relationship
Tuberculosis ■                                    ■          
Diabetes                                                     
Kidney Disease ■                                             
Heart Disease                                                
Arthritis Asthma, Hay Fever                              ■ \ 
Stomach Disease Epilepsy, Convulsions                        
Hypertension Cancer                                          
Other (specify)                                              
                                                                                                                                       HCHF – 2

PLEASE DIRECT               JuCUM – HEREDIA *              APARTADO 1444-3000                    *  HEREDIA, COSTA RICA
ALL FORMS TO:                  506/267-7063 *              FAX: 506/267-7063 *                   EMAIL: YWAMCR@RACSA.CO.CR                  8
                    YWAM Heredia                                                  “Knowing God and caring for His Creation”


                                                                                          PART B: PHYSICIAN’S EVALUATION

Applicant’s Name:                                                                 Date of Application:                                               _



TO THE PHYSICIAN:
Please review the information in PART A. Please treat all conditions that you feel require treatment and notify us of any problems that
you feel merit follow-up by the health service. Some conditions such as diabetes, epilepsy and heart disease may have an effect on the
location of the applicant’s outreach. Please ensure that any pertinent information in these areas has been included.

TO THE APPLICANT:
All required immunizations MUST BE COMPLETED BEFORE YOU WILL BE ACCEPTED AT YWAM-Heredia. Due to the varied outreach
locations, other immunizations, injections and malaria medication may be required and can be obtained before outreach. If you have
ever been vaccinated for cholera, typhoid, or yellow fever, please bring that information with you. Please be prepared financially to
cover the cost of additional injections.
You need to have a Diphtheria-Tetanus booster within the last 5 years. 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.

                      CHILDHOOD RECORD OF IMMUNIZATIONS                                               ADULT IMMUNIZATIONS
                                   BASIC                                                                     BOOSTER
                    Mo Day Yr             Mo Day Yr              Mo Day Yr            Mo Day Yr              Mo Day Yr             Mo Day Yr
Diphtheria        ____/____/____         ____/____/____          ____/____/____       ____/____/____      ____/____/____        ____/____/____

Tetanus          ____/____/____          ____/____/____         ____/____/____       ____/____/____       ____/____/____        _       _/____/____

Pertussis        ____/____/____          ____/____/____         ____/____/____       ____/____/____      _    _/____/_ ___      _       _/____/_ __

Polio            ____/____/____         ____/____/____          ____/____/____       ____/____/____       _   _/____/_ ___      _       _/____/_ __

Rubella           ____/____/____        ____/____/____          ____/____/____       ____/____/____       _   _/____/_ ___      _        _/____/_ __

Measles           ____/____/____         ____/____/____         ____/____/____        ____/____/____      _    _/____/_ ___        _     _/____/_ __

Mumps             ____/____/____         ____/____/____         ____/____/____        ____/____/____      _    _/____/_ ___        _     _/____/_ __



TUBERCULOSIS CONTROL (within 6 months of the school)
One of the following:
  Chest X-ray Date ____                ________ Result ______       ____________ Examination Facility ____                     ________________

  Skin Test*       Date _____       _________ Result _______ ________________ Examination Facility ______                             ______________
    *If your skin test is positive you MUST have a chest X-ray.


Date of last DT (Diphtheria/Tetanus) booster: Mo:                      Day:              Yr:                  (must be within the last 5 years)
Height: _____   ______/____      ________ Weight: ________ _____________ Overweight: __________                    _________________________

Blood Pressure: ______   ____    ___________________ Pulse: ______        ________________ Blood Type: ___ ____           __________________

Visual Acuity (without glasses): R___        ________ L _____       _______ (with corrective lenses) R_____      ______ L ______           ______


Urinalysis: ______________________________________    ________ Last Pap Smear (not compulsory): ___________                     ____________

                                                                                                                                           HCHF – 3
PLEASE DIRECT               JuCUM – HEREDIA *             APARTADO 1444-3000                   *  HEREDIA, COSTA RICA
ALL FORMS TO:                  506/267-7063 *             FAX: 506/267-7063 *                  EMAIL: YWAMCR@RACSA.CO.CR                         9
                      YWAM Heredia                                                      “Knowing God and caring for His Creation”


Are there any abnormalities of the following systems? Please describe fully.
Ears/ Nose/ Throat                                                                                                                                            _

Ophthalmological                                                                                                                                              _

Teeth _______________                                          _________________________________________________________________________________

Neurological __________________________                                            ________________________________________________________________

Cardiovascular _________________________________                                            ________________________________________________________

Respiratory ________________________________                                             __________________________________________________________

Musculoskeletal ____________________________________                                             ____________________________________________________

Endocrine _______________________________________________________________                                                  ______________________________

Lymphatic __________________________________________________________________                                                  ___________________________

Dermatological _________________________________________________________________________                                                   ________________

Hernial Orifices ________________________________________________________________________                                                  ________________

Urological ______________________________________________________________________________                                                   _______________

Psychiatric ______________________________________________________________________                                                  ______________________

Recommendations for Follow-up Tests / Treatment: _______________________________________                                         ________________________

Would he/she be able to walk 3 – 4 miles per day? ■ No  Yes
Additional Comments: ___________________________________                                          ___________________________________________________

__________________________________________________________________________________________                                                       ___________

How long has this patient attended your office? Years:                                  Months:                                Weeks:                         _

PHYSICIAN’S RECOMMENDATION:
■ Acceptable Without Limitations ■  Not Acceptable  Should Remain In Areas Where Adequate Medical Care Is Provided
■ Acceptable With Limitations (specify) _______                                   _____________________________________________________________


PHYSICIAN’S NAME: (print) _________                          ____ ________________________________________ DATE: __ _______                    __________

ADDRESS:                                                                                                 PHONE:                                           _

PHYSICIAN’S SIGNATURE: _______________                                             ______________________________________________________________



LEGAL CONSENT FOR MINORS:
I hereby give my consent for (give complete name of minor)                                                                                          to travel
outside the United States with Youth With A Mission.
Signature of parent or guardian                                                                                   Date                                        _

UNIVERSITY OF THE NATIONS IS A DEGREE GRANTING INSTITUTION (Associate, Bachelor, & Master), BUT IS NOT ACCREDITED BY ANY
ACCREDITING AGENCY OR ASSOCIATION RECOGNIZED BY THE UNITED STATES COMMISSIONER OF EDUCATION. University of the Nations
(U of N) admits students of any race, color, national, and ethnic origin to all rights, privileges, programs, and activities generally accorded or made
available to students at the school. It does not discriminate on the basis of race, color, national, and ethnic origin in administration of its educational
policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs.
                                                                                                                                                       HCHF - 4

PLEASE DIRECT                 JuCUM – HEREDIA *                 APARTADO 1444-3000                   *  HEREDIA, COSTA RICA
ALL FORMS TO:                    506/267-7063 *                 FAX: 506/267-7063 *                  EMAIL: YWAMCR@RACSA.CO.CR                           10
                   YWAM Heredia                                                 “Knowing God and caring for His Creation”


                                                                                                               CHILD HEALTH FORM
PARENT INFORMATION: Please print or type answers to ALL questions IN ENGLISH.
SCHOOL YOU ARE APPLYING FOR:                                          STARTING DATE:                                                            _

Last/Family Name:                                                  First:                                          Middle:                      _

Child’s Name:                                                      First:                                          Middle:                      _

Child’s Date of Birth: (DD/MM/YY)                        Age:                Birthplace:                                                        _

Do you have medical insurance? No  Yes Name of Insurer:                                                  Med. Ins. No:                        _

Med. Insurance coverage (briefly):                                                                                                              _

CHILD’S PERSONAL HISTORY
Please answer all questions and take both Part A and Part B to your physician. Comment on all positive answers on a separate sheet of
paper. The omission of health history problems or incomplete explanation of the same can lead to removal of acceptance status.
Have you ever had, or do you now have, any of the following:
                          NO YES                               NO YES            Has your child ever had any
Skin Condition ■            ■ Low Blood pressure ■                           of the following?
Eye Trouble ■               ■ Allergy: Bee Stings* ■                                                    NO YES
Ear Trouble ■                   ■   Allergy: Penicillin ■                            Chicken Pox                       
Head Injury ■                   ■   Allergy: Sulfonamides ■                          Measles (Rubella)                 
Recurrent Headaches ■           ■   Allergy: Serum ■                                 Measles (Rubeola)                 
Epilepsy ■                      ■   Allergy: Food (specify) ■                        Mumps                             
Fainting Spells ■               ■   Tumor/Cancer ■                                   Pertussis                         
Weakness ■                      ■   Rheumatism/Arthritis ■                           Scarlet Fever                     
Paralysis ■                     ■   Back Problems ■                                  Tuberculosis                      
Insomnia ■                      ■   Dislocation of Joints ■                          OTHER (specify)                                          _
Shortness of Breath             ■   Broken Bones ■                  
Hay fever ■                     ■   Stomach/Duodenal Ulcer ■  
Asthma ■                        ■   Gall Bladder Problems ■  
Hepatitis                       ■   Jaundice ■                      
Recurrent Diarrhea              ■   Intestinal Troubles ■           
Kidney Disease ■                ■   Diabetes ■                      
Venereal Disease ■              ■   Anemia ■                        
High Blood Pressure ■           ■   Heart Trouble                   ■
Mental/Nervous Disorders        ■   *If you are allergic to bee stings, you must bring your own up-to-date reaction kit

Other illnesses or conditions:                                                                                                                  _

_                                                                                                                                                 _

Is your child at present under a doctor’s care for any condition?  No  Yes Specify: _____________                     ____________________ ___

_                                                                                                                                               _

Is he/she taking any medication at this time?  No  Yes Specify: ________________________                            _________________________

__________________________________________PLEASE ARRANGE TO BRING ALL NECESSARY LONG-TERM MEDICATIONS WITH YOU
Is he/she allergic to any drugs?  No  Yes Specify:                                                                                            __

_________________________________________________________                                        ____________________________________________
Does he/she have any physical impairments, handicaps, or health conditions which require special attention?  No  Yes
Specify: _____________________________                                                       ______________________________________

                                                                                                            __________________________________

Is he/she underweight?  No  Yes Overweight?  No  Yes If so, how much?                                                                       _
Child’s Blood Type:                            O, A, B, AB (+ or -)                                                                    HCHF - C

PLEASE DIRECT              JuCUM – HEREDIA *             APARTADO 1444-3000                  *  HEREDIA, COSTA RICA
ALL FORMS TO:                 506/267-7063 *             FAX: 506/267-7063 *                 EMAIL: YWAMCR@RACSA.CO.CR                     11
                    YWAM Heredia                                               “Knowing God and caring for His Creation”


                                                                       STATEMENT of BURIAL and MEDIATION

Please mail signed form along with Application to:                Registrar: JuCUM – Heredia
                                                                  Apartado 1444-3000
                                                                  Heredia, Costa Rica
                                                                  Central America



BURIAL STATEMENT

We at Youth With A Mission Heredia encourage each YWAM student and volunteer to seriously consider some possible consequences of
missions work and training. Although death is extremely rare in service with Youth With A Mission internationally, it is never the less an
experience that awaits each one of us eventually. It is important that we all prepare for such possibilities and have a clear plan of
action if such instances arise during our time of study or service within Youth With A Mission.

In extensive travel in less developed countries, diseases are more prevalent, fatal accidents, sickness and mishaps can occur. YWAM
Heredia does everything possible to protect staff and students while on the field, but death is something that can occur. In these
countries, burial is often a real problem.

We endeavor to maintain a Christian view of death, it is not the final step, but just a passage; the person is not in the coffin, just his/her
earthly shell. Therefore the priority for limited resources on outreach must be for the living.

In case of death, YWAM Heredia cannot commit to cover the expenses of burial or transport home from the country of death (developed
or non-developed countries alike). We would strongly encourage burial on the field, as decay can start very quickly. Shipping a body
home could cost several thousand dollars and often a special expensive coffin is required by law in some countries as well as having
someone accompany the coffin on the return journey. If the family desires to see a body transported back home, the family must incur
the entire cost. Any burial costs incurred while on outreach (in the country that the death and burial occurs) are the responsibility of the
deceased’s family as well. Note: It is the responsibility of every individual or family (staff or volunteer) to have the Field Burial
or Death Related Remains Transport Insurance, not YWAM Heredia.



 I agree that in case of my death while on outreach in conjunction with Youth With A Mission Heredia, that they may carry out the burial
 in the location of my decease. If my family desires to see my body shipped home, they will agree to cover all expenses incurred. I
 hereby absolve Youth With A Mission Heredia, its staff and associates, from any responsibility for burial costs.


         Applicant’s Name:
         Applicant’s Signature:                                                                         Date:

         If applicant is under 18 years of age, the signature of a parent or responsible party is required.

         Parent/Guardian Signature:                                                            Relationship:




                                                                                                                                       HSBM
PLEASE DIRECT              JuCUM – HEREDIA *             APARTADO 1444-3000                *  HEREDIA, COSTA RICA
ALL FORMS TO:                 506/267-7063 *             FAX: 506/267-7063 *               EMAIL: YWAMCR@RACSA.CO.CR                     12
                    YWAM Heredia                                             “Knowing God and caring for His Creation”


                                   EMPLOYER / TEACHER / LEADER CONFIDENTIAL REFERENCE FORM
                                                                     (Please circle which is filling out this form)
TO THE APPLICANT: Please complete the information below and provide a stamped envelope addressed to the above
address for the person filling out this form.

Last/Family Name:                                                 First:                               Middle:

Current Address:

City:                                                   State/Province:                      Postal/Zip Code:

Country:                                                Course Date Applying For:

Phone Number:                                   Email:
I, the above named applicant, WAIVE any right to have or obtain copies of this recommendation knowing that this waiver
is NOT required as a condition for admission.

Applicant’s Signature:                                                                                 Date:

The above applicant has applied for admission to University of the Nations (U of N). U of N is a mission-oriented university under the
auspices of Youth With A Mission (YWAM), an international, interdenominational Christian missionary organization. YWAM, founded in
1960, now has centers in over 1200 locations on all six continents. Its purposes include training, challenging and channeling Christians
to fulfill Christ’s command: “Go, therefore, and make disciples of all nations.” U of N is a training and logistics base from which skilled
workers are sent out into the world.

Serious consideration will be given to your comments; therefore, we ask that you complete this form carefully. Your prompt attention in
completing this form (within 7 days) is important. Thank you for your assistance.

Please check the following and comment where necessary:

How long have you known the applicant? ____________ How well do you know the applicant?             Very Well  Well Casually
Please rate, according to what you have observed, the applicant’s effectiveness in the following areas:
                                    Superior         Above Average          Average         Below Average                 Inferior
Initiative                          ______              ______              ______            ______                      ______
Social adaptability                 ______              ______              ______            ______                      ______
Concern for others                  ______              ______              ______            ______                      ______
Ability to follow                   ______              ______              ______            ______                      ______
Leadership                          ______              ______              ______            ______                      ______
Judgment/Decision-making            ______              ______              ______            ______                      ______
Emotional stability                 ______              ______              ______            ______                      ______
Health                              ______              ______              ______            ______                      ______
Personal Appearance                  ______             ______              ______            ______                      ______

COMMENTS____________________________________                           ______________          __________________________________

________________________________________________________________                                    ______________________________
Mental ability ■              Quick to comprehend ■  Average ■                              Slow
Industry ■                            Hard worker ■                        Average ■                 Lacks persistence
Reliability ■                         Meets obligations ■                  Average ■                 Neglects obligations
Cooperativeness ■                     Works well with others ■             Average ■                 Avoids group activity
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______________________________________________                                   ______________________________________

__________________________________________________                  _________                ___________________________________
                                                                                                                                REF. E/T – 1

PLEASE DIRECT                JuCUM – HEREDIA *          APARTADO 1444-3000               *  HEREDIA, COSTA RICA
ALL FORMS TO:                   506/267-7063 *          FAX: 506/267-7063 *              EMAIL: YWAMCR@RACSA.CO.CR                     13
                      YWAM Heredia                                                      “Knowing God and caring for His Creation”

To what extent is the applicant active in church work? ____________________________________________________ ___________

Does he/she display high moral standards?           Yes  No        Comment:_________________                           _________________________

Is he/she prejudiced against groups, races, or nationalities?          Yes No        Please explain: _________________ _________________

_________________________________________________________________________                                            ____________________________

With reference to his/her Christian service, do you consider the applicant to be: ■ Dedicated                    Average  Casual
Please explain:                                                                                                                                             _

In your consideration, which of the following best describe the applicant’s Christian experience?
            Mature           Contagious ■          Genuine and Growing ■            Over-emotional ■                         Superficial
Comments:                                                                                                                                                       _

_                                                                                                                                                              _

Overall, what do you consider to be the applicant’s strong points? (include special abilities) __________________________________

___________________________________________________________                           _____________________________________ __                              __

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

_________________________________________________________                           ________ _________________ ____                          _____________

In your opinion, what are the applicant’s reasons for applying to the U of N? __________                     _____________________________________

______________________________________________________________________________                                           ____         ________ __________

What could the U of N do to aid in the applicant’s personal development? _________________________                              ________________________

_________________________________________________________________________                               _____________                     _______________
Please add any other relevant remarks (i.e., medical, psychological, drugs, alcohol, or other areas of their life we should know more

about, to be of service to them):                                                                                                                              _

_______________                  _____________________________             ______________________________                    _________                    ___

__________________________________________________________________________                               _______________________                        __ __
Would you recommend the applicant for acceptance into the University of the Nations?
 Yes  With some reservation (please explain) ■ No (please explain)                                                                                          _

____________________________________                   _______________________________________                           _____________        ____________

I have known ___________________________________________                           ___________________________ for ________________ years
and believe that he/she possesses the qualities indicated above.

Signed : _________________________________________                                 ______       ________ Date: ________              __________ _______

Name (please print): ___________            __________________________________________ Position: __________                             _________ ______

Address: __________________________________________________________________________                                                         ______ ______

City: _______________________                               ___________ State/Province: __ ________ Postal/Zip Code: _ ______________

Country: ____________                       _________ __________________ Phone: ___                      ________ ____________________________

    ■ Please send me more information about YWAM.
UNIVERSITY OF THE NATIONS IS A DEGREE GRANTING INSTITUTION (Associate, Bachelor, & Master), BUT IS NOT ACCREDITED BY ANY
ACCREDITING AGENCY OR ASSOCIATION RECOGNIZED BY THE UNITED STATES COMMISSIONER OF EDUCATION. University of the Nations
(U of N) admits students of any race, color, national, and ethnic origin to all rights, privileges, programs, and activities generally accorded or made
available to students at the school. It does not discriminate on the basis of race, color, national, and ethnic origin in administration of its educational
policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs.
                                                                                                                                                   REF. E/T - 2


PLEASE DIRECT                  JuCUM – HEREDIA *                APARTADO 1444-3000                    *  HEREDIA, COSTA RICA
ALL FORMS TO:                     506/267-7063 *                FAX: 506/267-7063 *                   EMAIL: YWAMCR@RACSA.CO.CR                           14
                      YWAM Heredia                                           “Knowing God and caring for His Creation”


                                                                          FRIEND CONFIDENTIAL REFERENCE FORM
TO THE APPLICANT: Please complete the information below and provide a stamped envelope addressed to the above
address for the person filling out this form.
   Last/Family Name: ______________                  ________________ First: ______              _______________ Middle: __________

Current Address: __________________                     _______________________________________________________________

City: ______________                 _____ ______________ State/Province: ____            ___ Postal/Zip Code: ______         _________

Country: _______________               ________________ __ Course Date Applying For: __                  _________________________

Phone Number: _______                 ________ _______ ___ Email: _________          ___ ____________________________________

I, the above named applicant, WAIVE any right to have or obtain copies of this recommendation knowing that this waiver
is NOT required as a condition for admission.

Applicant’s Signature ________      __________________________________________                __________ Date ____        ____________

The above applicant has applied for admission to University of the Nations (U of N). U of N is a mission-oriented university under the
auspices of Youth With A Mission (YWAM), an international, interdenominational Christian missionary organization. YWAM, founded in
1960, now has centers in over 1200 locations on all six continents. Its purposes include training, challenging and channeling Christians
to fulfill Christ’s command: “Go, therefore, and make disciples of all nations.” U of N is a training and logistics base from which skilled
workers are sent out into the world.

Serious consideration will be given to your comments; therefore, we ask that you complete this form carefully. Your prompt attention in
completing this form (within 7 days) is important. Thank you for your assistance.

Please check the following and comment where necessary:

How long have you known the applicant?                  How well do you know the applicant?     Very Well  Well  Casually
Please rate, according to what you have observed, the applicant’s effectiveness in the following areas:
                                Superior       Above Average          Average         Below Average                      Inferior
Initiative                      ______             ______              ______           ______                           ______
Social adaptability             ______             ______              ______           ______                           ______
Concern for others              ______             ______              ______           ______                           ______
Ability to follow               ______             ______              ______           ______                           ______
Leadership                      ______             ______              ______           ______                           ______
Judgment/Decision-making        ______             ______              ______           ______                           ______
Emotional stability             ______             ______              ______           ______                           ______
Health                          ______             ______              ______           ______                           ______
Personal Appearance             ______             ______              ______           ______                           ______

COMMENTS ________                    _______________     ______________________________________________________________________

___________________                    _______________ _____________________________________________________________________

Mental ability ■                      Quick to comprehend ■               Average ■                  Slow
Industry ■                            Hard worker ■                       Average ■                  Lacks persistence
Reliability ■                         Meets obligations ■                 Average                    Neglects obligations
Cooperativeness ■                     Works well with others ■            Average ■                  Avoids group activity
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:                                                                                                                                    _



                                                                                                                                    REF. F - 1

PLEASE DIRECT              JuCUM – HEREDIA *            APARTADO 1444-3000               *  HEREDIA, COSTA RICA
ALL FORMS TO:                 506/267-7063 *            FAX: 506/267-7063 *              EMAIL: YWAMCR@RACSA.CO.CR                      15
                      YWAM Heredia                                                      “Knowing God and caring for His Creation”


To what extent is the applicant active in church work? _____________________________________ ____ ______________________

Does he/she display high moral standards? ■Yes                      No Comment: ___________________                       ________________ _________

Is he/she prejudiced against groups, races, or nationalities?                 Yes ■No Please explain:________________________________
______________                              _______________________________________________________________________________________
With reference to his/her Christian service, do you consider the applicant to be:                         Dedicated  Average  Casual
 Please explain:

In your consideration, which of the following best describe the applicant’s Christian experience?
       Mature ■  Contagious ■  Genuine and Growing ■  Over-emotional ■                                                     Superficial
Comments: __________________________                                   ___________________________________________________________________

_____________________________                                    _______________________________________________________________ ________

Overall, what do you consider to be the applicant’s strong points? (Include special abilities) ______                                 _________________

__________________________________________________________________                                               ___________________________________

Please comment on the applicant’s family background (if known): ______________________ _________________________________
______________________________________________________________________                                                _______________________________

In your opinion, what are the applicant’s reasons for applying to the U of N? ____                                                                 _________

             ______________________________________________________                        ___________________________________________________

What could the U of N do to aid in the applicant’s personal development? ____________________ ___________________________
__________________________________________________                                          ___________________________________________________
Please add any other relevant remarks (i.e., medical, psychological, drugs, alcohol, or other areas of their life we should

know more about, to be of service to them ):__________________________________________ ___________________________________
___________________________________________________________________________________________                                                      __________
Would you recommend the applicant for acceptance into the University of the Nations?
 Yes ■ With some reservation (please explain)  No (please explain) _______________________________                                          ____________

_____________________________________                                                                                            ______________________

I have known:                                                                                                         for                               years
and believe that he/she possesses the qualities indicated above.

Signed:                                                                                                    Date:

Name (please print):                                                                               Position:

Address:

City:                                                           State/Province:                             Postal/Zip Code:

Country:                                                                              Phone:
■
 Please send me more information about YWAM.
UNIVERSITY OF THE NATIONS IS A DEGREE GRANTING INSTITUTION (Associate, Bachelor, & Master), BUT IS NOT ACCREDITED BY ANY
ACCREDITING AGENCY OR ASSOCIATION RECOGNIZED BY THE UNITED STATES COMMISSIONER OF EDUCATION. University of the Nations
(U of N) admits students of any race, color, national, and ethnic origin to all rights, privileges, programs, and activities generally accorded or made
available to students at the school. It does not discriminate on the basis of race, color, national, and ethnic origin in administration of its educational
policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs.
                                                                                                                                                     REF. F - 2



PLEASE DIRECT                  JuCUM – HEREDIA *                APARTADO 1444-3000                    *  HEREDIA, COSTA RICA
ALL FORMS TO:                     506/267-7063 *                FAX: 506/267-7063 *                   EMAIL: YWAMCR@RACSA.CO.CR                           16
                    YWAM Heredia                                             “Knowing God and caring for His Creation”


                                                                        PASTOR CONFIDENTIAL REFERENCE FORM
TO THE APPLICANT: Please complete the information below and provide a stamped envelope addressed to the above
address for the person filling out this form.
  Last/Family Name: _____________________            _________ First: ________           ________     _____ Middle: _______ __ _____

 Current Address: _______________                    ______________________________________________________                     ___ ____

  City: ________________________             _           ________ State/Province: __      _____ Postal/Zip Code: __ _        __________

 Country: ___________             ______________________ Course Date Applying For: _________                       __________________

Phone Number: ___________        _________________ Email: _______                   _________________________________________

I, the above named applicant, WAIVE any right to have or obtain copies of this recommendation knowing that this waiver
is NOT required as a condition for admission.
Applicant’s Signature _______________________            ____________________       _________________ Date _____             __________

The above applicant has applied for admission to University of the Nations (U of N). U of N is a mission-oriented university under the
auspices of Youth With A Mission (YWAM), an international, interdenominational Christian missionary organization. YWAM, founded in
1960, now has centers in over 1200 locations on all six continents. Its purposes include training, challenging and channeling Christians
to fulfill Christ’s command: “Go, therefore, and make disciples of all nations.” U of N is a training and logistics base from which skilled
workers are sent out into the world.

Serious consideration will be given to your comments; therefore, we ask that you complete this form carefully. Your prompt attention in
completing this form (within 7 days) is important. Thank you for your assistance .

Please check the following and comment where necessary:
How long have you known the applicant? ____           ____ How well do you know the applicant?        Very Well     Well     Casually

Please rate, according to what you have observed, the applicant’s effectiveness in the following areas:

                                         Superior        Above Average             Average         Below Average        Inferior
Initiative                                 ______             ______                ______             ______            ______
Social adaptability                        ______             ______                ______             ______            ______
Concern for others                         ______             ______                ______             ______            ______
Ability to follow                          ______             ______                ______             ______            ______
Leadership                                 ______             ______                ______             ______            ______
Judgment/Decision-making                   ______             ______                ______             ______            ______
Emotional stability                        ______             ______                ______             ______            ______
Health                                     ______             ______                ______             ______            ______
Personal Appearance                        ______             ______                ______             ______            ______

COMMENTS___________________                       _______________________________________________________________ ___________

_____________                   _______________________________________________________________________________ ___________
Mental ability ■                      Quick to comprehend ■               Average ■                  Slow
Industry ■                            Hard worker ■                       Average ■                  Lacks persistence
Reliability ■                         Meets obligations ■                 Average ■                  Neglects obligations
Cooperativeness ■                     Works well with others ■            Average ■                  Avoids group activity
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 ______________________________                           _______________________________________________________________

_________________                     ______________________________________________________________________________________

                                                                                                                                   REF. P – 1
To what extent is the applicant active in church work?                                                                                      _
PLEASE DIRECT                JuCUM – HEREDIA *           APARTADO 1444-3000              *  HEREDIA, COSTA RICA
ALL FORMS TO:                   506/267-7063 *           FAX: 506/267-7063 *             EMAIL: YWAMCR@RACSA.CO.CR                     17
                      YWAM Heredia                                                    “Knowing God and caring for His Creation”


Does he/she display high moral standards?          Yes  No Comment: ___________________________ ____________                                    __         _
Is he/she prejudiced against groups, races, or nationalities? ■ Yes   No Please explain: ________ _______ ______ __                               _ ____

_____________________________________________________________________________________                                                    _______________
With reference to his/her Christian service, do you consider the applicant to be: ■ Dedicated                 Average Casual
Please explain _________________________                                                                                _________                 ________

                                      _________________________               _________                                        _                       ______
In your consideration, which of the following best describe the applicant’s Christian experience?
           Mature ■  Contagious ■  Genuine and Growing ■  Over-emotional                                         Superficial
Comments: _______________________                        _______________                                           __                _____ ____________

_______________________________________________________________________________________________ ________                                                ____

Overall, what do you consider to be the applicant’s strong points? (include special abilities) _____                         ______ __        _     ____

________________________________________________________                                                                     _______                     ___

Please comment on the applicant’s family background (if known): _______                            ________________________            _________        ___

_______________________________                     ________________________________________________________________                                    ___

In your opinion, what are the applicant’s reasons for applying to the U of N ?________________                           ___ __ _________          ______

__________________________________________________________                                                                  __________                       _

What could the U of N do to aid in the applicant’s personal development ?___________________________________________ _                                 _ ___

_____________________________________________________                                                      _____________________                         __
Please add any other relevant remarks (i.e., medical, psychological, drugs, alcohol, or other areas of their life we should know more
about, to be of service to them)______________________________________________________________________                _ ____         ___

____________________________________________________________________                                ___________________ ________                         __
Would you recommend the applicant for acceptance into the University of the Nations?                 Yes  With some reservation (please
explain)    No (please explain
                                                                                                                                                             _
Is your congregation/group standing behind the applicant with enthusiasm and prayer?                   Yes  No         Please explain:

________                                                                                                                                               _____

_________________________________________________________________                                            ____________________________________

I have known _______________                  ________________________________________________ for _______________ years
and believe that he/she possesses the qualities indicated above.

    Signed : ___________                                ___________________ ________________________ Date: ___                             ____________

Name (please print): ________________________________                      _____________ Position: __________                         _______________

Address: _________________                                       ________________________________________                 __________________________

City: _____________ ______                          _    ______________ State/Province: ____             __ ___ Postal/Zip Code: _         ___________

Country: ____________________                            _______          _____________ Phone: ____ _                __________________________

   Please send me more information about YWAM.
UNIVERSITY OF THE NATIONS IS A DEGREE GRANTING INSTITUTION (Associate, Bachelor, & Master), BUT IS NOT ACCREDITED BY ANY
ACCREDITING AGENCY OR ASSOCIATION RECOGNIZED BY THE UNITED STATES COMMISSIONER OF EDUCATION. University of the Nations
(U of N) admits students of any race, color, national, and ethnic origin to all rights, privileges, programs, and activities generally accorded or made
available to students at the school. It does not discriminate on the basis of race, color, national, and ethnic origin in administration of its educational
policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs.

                                                                                                                                                  REF. P - 2


PLEASE DIRECT                 JuCUM – HEREDIA *                APARTADO 1444-3000                   *  HEREDIA, COSTA RICA
ALL FORMS TO:                    506/267-7063 *                FAX: 506/267-7063 *                  EMAIL: YWAMCR@RACSA.CO.CR                           18

				
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