SOLD OUT Application

SOLD OUT Application
Thank you for applying to Youth With A Mission Charlotte!

May you know the Lord's grace as you seek His direction. In order for us to process your application, we must receive all of the following completed forms.

1. Student Application Form: Please answer every question. If one does not apply to you, write N/A in the blank. Married couples enrolling as stuends but complete separate applications.

2. Application Fee: A nonrefundable Application Fee of $35.00 USD for singles and $50.00 USD for married couples is to be included with your application. Your application cannot be processed without it.

3. Three Reference Forms: One of these forms is to be given to your pastor and one to your DTS leader. Ask them to complete the form and email or mail it directly to YWAM Charlotte.

4. Confidential Health Form: This needs to be filled out by both you and your physician.

5. Consent for Treatment/Liability Release Form: The applicant must sign this form. Parents must also sign if the applicant is under 18 years of age.

Please direct all forms to:

Youth With A Mission Charlotte

418 East Franklin Street - Monroe, NC 28112
Personal Information
Full Name *

First Name Middle Name Last Name
E-mail *

Permanent Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Cell Phone Number *

Area Code Phone Number
Birth Date *

Month Day Year
Gender *

Male Female
Upload a Photo of Yourself
Marital Status *
Spouse's Name

First Name Last Name
Ethnic background
Do you have children accompanying you? *

Yes No
If yes, please give their name, birthday, grade in school, and gender:

Personal History
How long have you had a relationship with the Lord? How would you best describe it? *
Describe other significant experiences that you have had and how they have influenced your walk with the Lord. *
What areas of your character are you presently seeking God to further develop and improve? *
Other than DTS, have you had any previous mission experiences? *
Describe what missions means to you. *
What are some of your personal dreams and long term goals? *
List any previous leadership experiences, length, and capacity of position held. *
What books, websites, music and/or other media have influenced you the most? *
What talents and hobbies do you have? *
Describe your relationship with your church. How do they feel about you enrolling in SOLD OUT? *
Describe your relationship with your family. How do they feel about you enrolling in SOLD OUT? *
Have you ever had any physical disabilities or do you have any special dietary needs? *
Do you currently use or have any history of using tobacco, alcohol, marijuana, or other drugs? If so, when? Please explain. *

In addition to YWAM Charlotte, have you applied to any other YWAM bases? *
Financial Information
Do you have your complete school fees? *

Yes No
If you do not have your complete fees, how much do you have?
From what source will the remainder come? *
Do you have any outstanding debt? *

Yes No
If yes, please explain:
I understand that payment of the required school tuition fees must be made in US currency prior to my arrival, unless otherwise approved in writing by the school leader before my departure for North Carolina. I also confirm that I am fully aware of my financial obligations, both to the Lord and to the students and staff of the school. I therefore, commit myself to paying all personal expenses during my involvement with Youth With A Mission. I certify that all information in this application is accurate and complete. If accepted by Youth With A Mission, I will abide by the spirit, guidelines and schedule of the program.
Electronic Signature: *

First Name Middle Name Last Name
Date:

Month Day Year Date Picker Icon

Church Background
Your home church: *
Denomination: *
How long have you attended this church? *
Pastor's Name

First Name Last Name

Church Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Church Phone Number

Area Code Phone Number
Church or Pastor's E-mail

Previous YWAM experience
Where did you do your DTS? *
Dates attended:
Why do you want to attend this school? *
What are your expectations for this course? *

Passport & Visa Information
Country of Citizenship *
Name as it is recorded in your passport:

First Name Middle Name Last Name
Passport Expiration:

Month Day Year
Visa type:
Country of Visa Issuance:
Date Visa Issued

Month Day Year
Visa Expiration Date:

Month Day Year
Have you ever been refused a visa? *

Yes No
If yes, please explain in detail:

In Case of Emergency Contact:
Full Name *

First Name Last Name
Relationship to you: *

Mother Father Friend Other

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

Area Code Phone Number
Cell Phone Number *

Area Code Phone Number
E-mail *

Health History Form
To the applicant: During this program you may find yourself at times in a geographical location without ready access to medical facilities. In order to provide the best possible care for you during your time with us we are obligated to ask the following questions. This information is treated confidentially and separate from your academic records. Please complete this form in English.
Your name *

First Name Last Name
Confidential Health Form
Every student is required to have basic health insurance while on outreach.
Insurance Coverage *

Yes, I currently have health insurance No, I do not currently have health insurance
Medical Insurance Company
Policy Number
Phone Number

Area Code Phone Number
Does your insurance cover you outside of your home country or the United States?

Consent for Treatment
In the event of injury or illness of the undersigned (Applicant) while in association with YOUTH WITH A MISSION, I/we hereby agree to the performance of such treatment, anesthetics, and operations as, in the opinion of the attending physician, is deemed necessary.
Electronic Signature (type your full name): *

First Name Middle Name Last Name
Parent/Legal Guardian's Electronic Signature (if Applicant is under 18):

First Name Middle Name Last Name
Today's Date *

Month Day Year Date Picker Icon
Liability Release
I/we hereby release YOUTH WITH A MISSION, INC., its agents, employees, and volunteer assistants from any liability whatsoever arising out of an injury, damage, or loss which may be sustained by the undersigned (Applicant) during the course of involvement with YOUTH WITH A MISSION, INC.
Electronic Signature (type your full name): *

First Name Middle Name Last Name
Parent/Legal Guardian's Electronic Signature (if Applicant is under 18):

First Name Middle Name Last Name
Today's Date *

Month Day Year Date Picker Icon

Signature of Agreement
I certify that all information in the application is complete and accurate. I understand that if any information given is found to be false it could result in my removal or exclusion from the course.

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

I understand that payment of required tuition fees must be made upon or before arrival. I am fully aware of my financial obligation, both to the Lord and to the students and staff at Youth With A Mission. I therefore commit myself to paying all personal expenses incurred during my involvement with Youth With A Mission.
I agree to all of the above statements. *

Yes No
If you answered no to the above statement please explain:
Applicant's Electronic Signature (type your full name): *

First Name Middle Name Last Name
Parent/Legal Guardian's Electronic Signature (if Applicant is under 18):

First Name Middle Name Last Name
Today's Date *

Month Day Year Date Picker Icon
Should be Empty:

SOLD OUT Application

Personal Information

Personal History

Financial Information

Educational Background

Language Proficiency

Employment Background

Church Background

Previous YWAM experience

Passport & Visa Information

In Case of Emergency Contact:

Health History Form

Confidential Health Form

Personal Health History

Consent for Treatment

Liability Release

Signature of Agreement