DTS Application Please submit a picture of yourself to student.registrar@ywamtokyo.org Name * First Name Last Name Citizenship * Place of Birth * Date of Birth * MM DD YYYY Gender * Female Male Marital Status * Single Married Divorced Widowed Do you have children? If yes, please write their names and birth dates. Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email Emergency Contact Emergency Contact * First Name Last Name Emergency Contact's relationship to you * Emergency Contact's Email Emergency Contact's Phone Number * Passport Do you have a Passport? * Yes No Passport Number * Date of Issue * MM DD YYYY Date of Expiry * MM DD YYYY Country of Issue * Work Experience Current Occupation * Work History * Education Experience Highest Level of Education * Highschool Associate Degree Bachelor's Degree Graduate or Professional Degree Some College Other Area of Study or Major(s) Date Completed MM DD YYYY Language Proficiency English * (If English is your second language then we will need to do a phone interview to confirm that you will be able to fully benefit from the training you will undertake.) None Limited Words Basic Conversation Advanced Fluent Mother tongue Japanese * None Limited Words Basic Conversation Advanced Fluent Mother tongue Financial Information Do you have complete school fees? * Yes No If no, how do you anticipate the provision of the outstanding balance? Do you have financial support? * Yes No Personal History Describe your current relationship with the Lord Jesus. How and when did He become real to you? * Explain in detail, two areas of your character you really want to grow. * Please provide details about your current and past church involvement. * Please describe your relationships with your immediate family. * Are they supportive of you attending DTS? Yes No Neutral Other What are your talents and abilities (eg. music, computers, mechanics, children etc.) * What Christian books or periodicals have influenced you the most? * What are your personal purposes for doing a DTS? What are your expectations, motivations and the outcomes you are looking for? Why Tokyo specifically? * What are your hopes or plans after DTS? * Are you considering further training or ministry with YWAM afterwards? If so, please specify. How did you hear about YWAM/DTS? * Health Height (cm) * Weight (kg) * Do you have food allergies? * Yes No If yes, please specify Do you have any special dietary restrictions, i.e. vegan, vegetarian * Do you have any other allergies? (eg: drugs, medication) * Yes No If yes, please specify Do you have any issues regarding sleep that requires attention? * Yes No If yes, please specify Are you presently seeing a doctor? * Yes No If yes, please specify Are you presently taking any medication? * Yes No If yes, please specify Do you have any physical impairments, handicaps, or health conditions which require special attention? * Yes No If yes, please specify How would you rate your overall health condition? * Very bad Bad Neutral Good Very good Is there anything else that you would like to tell us about your health? Financial Responsibility Agreement Agreement * I have read and agree to the Financial Responsibility Agreement Release Liability Agreement Agreement * I have read and agree to the Release Liability Agreement Consent for Treatment Agreement * I have read and agree to the Consent for Treatment form In the event of... Please select on of the following in case of your death overseas: * 1. I hereby give consent to Youth With A Mission, its agents, employees, or voluntary assistants to arrange for my body to be buried, cremated (whichever is the most customarily suitable in the country of my death) in the event of death overseas. 2. I hereby declare that in the event of my death overseas, it is my request that my body be returned to my home country at the expense of my estate. I nominate as the executor of my will: Executor's Name First Name Last Name Phone (###) ### #### Executor's Address Address 1 Address 2 City State/Province Zip/Postal Code Country Agreement * I agree to the above agreement, which I have selected Finishing Up Final Agreement * I have truthfully completed all portions of this application for admissions to the school for which I am applying. If I am accepted into Youth With A Mission, I will abide by the spirit, rules, and schedule of the school. Thank you! Financial Responsibility Agreement Release Liability Agreement Consent for Treatment
