YWAM Living Stone
University Of the Nations Seminars & Modules
(2007-12010 APPLICATION FORM)

Personal Information
Full names exactly as in passport 	
Date of birth		Place of Birth		Sex	F	M
Street address	
Email address		Passport Number	
Married?	Widowed?	Seperated?	Divorced?	Engaged?	Single?
Details of family members accompanying you			
Spouse Names 			Birthdate (dd/mm/yyyy) 	
Son/daughter			Birthdate (dd/mm/yyyy)	
Son/daughter			Birthdate (dd/mm/yyyy)	
Son/daughter			Birthdate (dd/mm/yyyy)	
Contact details for next of kin	

Thank you for applying to YOUTH WITH A MISSION Living Stone! May you know God's grace as you seek His direction and perfect will in your life. In order for us to process your application, we must receive all the forms completed by you or the people concerned. If a question does not apply to you, please write N/A in the space. Husbands and wives enrolling as students must complete separate applications and pay USA a single $50 registration.

1	APPLICATION FEE:  A non-refundable Application fee of U.S.A. $50 is to be forwarded with the application. Your application cannot be processed without it. All cheques must be crossed and made payable to the account of Youth With A Mission. Money can also be sent through Western Union Money Transfer, but the ideal is to wire the application fee to this account (email us as soon as it is done): Youth With A Mission, Acct: 044051 000000 4611, Zambia National Commercial Bank Ltd, Main Branch, Livingstone, ZAMBIA.(ROUTING NUMBER [SWIFT CODE]: ZNCOZMLU)

2	FINANCIAL AGREEMENT: Please read carefully, complete and sign the Financial Policy and Indemnity Form. Please note that signing this form commits you to payment of the fees as set out in the Financial Policy.

3	REFERENCE FORMS:  You need to make 2 copies of the Confidential Reference Form and on each one fill in your name, the school you are applying for and the starting date. Hand one to your pastor, one to each of your two other referees (one of these is your last School Leader (if you have done a YWAM School). Ask them to complete the form and post it directly to YWAM Livingstone. We must receive at least two of the reference forms BEFORE we can process your application. Please submit two recent passport-size photographs with your application. IMPORTANT! All students are encouraged to apply early, generally about 2 months prior to the start of the school.

•	Write a testimony of when and how you got saved (born-again) giving details of the changes in your life and the present state of your spiritual walk today.

ADDITIONAL INFORMATION
Name of your Church and its street address	

Name of Pastor		Email Address	
Language proficiency	1	2	3	4	5	6	1 = very little, 6 = mother tongue
English											
French											
Portuguese/Spanish											
Any other Language											
YOUR HIGHEST ACADEMIC ACHIEVEMENTS AND HEALTH ISSUES
Years of Primary school completed	1	2	3	4	5	6	7	8	9
Years of Secondary school completed	1	2	3	4	5	6	7	8	9
Years of College/university completed 	1	2	3	4	5	6	7	8	9

Are you pursuing a UofN degree?			Which College	
Physical height		Weight		Blood type		

Allergies (specify what drugs, foods, and conditions you are allergic to)

Are you on a special diet?	Yes?	No?	Are you able to walk 5 miles (8km) in one day?
 Ensure that the form is filled in completely. Every question is important. Thanks for your patience!

LEGAL COMMITMENTS

In the case of an emergency I/we hereby agree to the performance of such treatment, including anaesthesia and surgery, as the attending doctor or physician may deem necessary. Applicant's dated signature, or dated signature of Parent/Guardian (with an explanation of signatory's relationship to the prospective student) is required if applicant is under 18 years of age.
Signed		Date		Relationship	
Signed		Date		Applicant's signature in this line

Do you agree to the following two declaration? (If "yes" sign this agreement): (A) I am willing to submit myself to YWAM leadership and co-operate with them at all times for the duration of my involvement with this mission and its programs. (B) I declare that the contents of this application form are correct and truthful (to the best of my knowledge). 
Signed		Date		Applicant's signature in this line

FINANCIAL AGREEMENT
Do you have outstanding debts?	YES?	NO?	How much?	
How and by when do you intend to pay it?	

Do you have sufficient finance to pay for your training? If no, how do you intend raising it (briefly explain)?

DECLARATION OF FINANCIAL RESPONSIBILITY
I/We have read and understand the Financial Policy of YWAM Livingstone. I/We understand that the payment of the required school fees must be made prior to or at registration, unless otherwise approved in writing by the Director. Further, I agree to meet in a timely manner, prior to the completion of the school, all personal expenses incurred during my involvement with Youth With A Mission, and that failing to do so, the cost of recovering any outstanding fees due to YWAM shall be borne by us/myself.  Parent/Guardian is required to sign if applicant is under 18 years of age.
Signed		Date		Relationship	
Signed		Date		Applicant's signature

INDEMNITY AGREEMENT
I/We do hereby agree that I will not hold Youth With A Mission, its staff, agents and volunteer assistants responsible for any illness, injury, damage or loss incurred by said person(s) during the course of involvement with Youth With A Mission.
I/We further agree that in case of illness or death all the costs of medication, transportation or burial will be borne by the family (parent/guardian or next of kin). In case of death, and my family is not able to transport my body home for burial, we/I allow YWAM Zambia to bury my body in the country of my death (if it is within their means to do so). 
I further declare that I have satisfied a reputable physician's examination and have been approved to travel and live in Africa for the duration of the School.
Signed		Date		Relationship	
Signed		Date		Applicant's signature in this line

FINANCIAL POLICY 2007-2010

The cost schedules below only include registration fees, transport to Outreach locations, and the cost of food and tuition during the Lecture Phase and the Outreach Phase. The cost of multiple entry visas and other personal expenses are not included. Our policy is to have zero hidden costs so that the student does not have to source extra finances to cover School expenses. 
•	PAYMENT PLANS 
A. Normal plan: 100% on the day of registration. 
B. Deferred plan: 66.66% on day of registration and balance paid four weeks later.
•	PAYMENT FOR OUTREACH PHASE
The entire amount plus transport to Outreach location must be paid before the eleventh week of the Lecture Phase.
•	PAYMENT SCALE PER 20 WEEK COURSE (Registration, lecture and Outreach phase, and Transportation charge to regional outreach locations only)
1.	The whole course costs ZK 3,000,000 for African students (and any other nationality classified as Category C by the University of the Nations)
2.	the whole course costs $1550 for Category B students eg, Brazilians, South Africans, etc (US$500 of this amount is for transportation and it is kept by the student).
3.	Category A students e.g. First World students pay $2550 (US$500 of this amount is for transportation and it is kept by the student).
 The variation in the scale is based on an understanding of the principle of justice reflected in the sacrificial system in the Bible. The one who offered a bull rejoiced with the needy who offered doves and pigeons before God. We celebrate your identification with YWAM Zambia and believe your choice of studying with at YWAM Living Stone is your investment into this School and the ministry calling of this Base in Africa. If you are financially distressed, let us know early.

•	The exchange rates in Zambia can fluctuate to the point where the base might lose as much as 33% of the value of foreign currencies. Add to this, bank charges are very high in Zambia. For this reason we advise all students should wire funds to our Account and Zambia National Commercial Bank, Livingstone Branch or send it via Western Union Money Transfer.
•	Our refund policy reflects the local cost of transferring money and the seriousness we attach to blocking off a space on our schools. We will refund 100% to students who cancel before the first week of the School applied for (of course the cost of the transfer will be deducted from the amount refunded). A student who withdraws after one week will be refunded 75%, after two weeks 50%, after 3 weeks 25% and nothing (no refunds) after the 4th week.

UOFN/YWAM LIVING STONE CONFIDENTIAL REFERENCE FORM

NAME:_____________________________ SCHOOL APPLIED FOR:___________________. The above named applicant has applied for admission to the above-named school at Youth With A Mission Livingstone. In order to adequately evaluate the applicant for admission, we would appreciate your supplying the information requested on this form. Your comments will help us to make a wise decision in accepting the applicant and to effectively meet his/her needs should he/she be accepted into the program applied for.

How long have you known the applicant (circle # of years right)?	1	2	3	4	5	6
In what capacity?	Church related?	Business Related?
					School related?	Family connection?

How well do you the applicant (on a scale of 1 to 9)?	1	2	3	4	5	6	7	8	9
 For how long has applicant attended your church? 	1	2	3	4	5	6	7	8	9
In what ways has the applicant been involved in the church and its program?

In your association with the applicant, what level of commitment have you seen exemplified?
	Faithful		Inconsistent		Erratic		Uncommited

In your consideration, which of the following best describes the applicant's Christian experience?
	Mature		Genuine and growing		Superficial/over-emotional

Rate the applicant in the areas below using the most applicable descriptor (good, fair, or poor).
Initiative		Grooming		Leadership		Followership	
Industrious 		Cooperation		Stability		Punctuality	
Adaptability		Discipline		Temperament		Flexibility	
Reliability		Character		Under stress 		Stewardship	
Perseverance		Attitude to other race in mixed team		Speech	

Please highlight words or descriptions which fit the applicant:
 impatient,  intolerant,  argumentative, domineering,  critical of others, easily embarrassed,  offended, discouraged,  frequently worried,  anxious,  nervous or tense,  given to moods,  prejudiced towards groups/races/nationalities,  addictive behaviour (history of drug use or unacceptable sexual involvement), unable to cope with stress,  erratic, loner, depressed, vengeful, fits of rage, etc.
Kindly shed more light on any word you have circled (use extra paper if necessary).

Is the applicant financially responsible?	Comment

Does he or she respond well to authorities?	Comment

Do you recommend her/him wholeheartedly?	Comment

I declare that the contents of this confidential reference are correct to the best of my knowledge.

Name 		Signed		Date	
Your e-mail address:	Email us at: ywamstone@yahoo.com or ywam.livingstone@gmail.com

PHYSICIAN’S EVALUATION

Name of Applicant: _______________________________School _______________________________

•	IMMUNIZATIONS
Because of the nature of mission work, there is a high risk of exposure to communicable diseases. YOUTH WITH A MISSION does not take responsibility for anyone who gets contaminated by the blood or body fluids of another person and thereby contracts HIV, hepatitis or any other communicable disease.
YOUTH WITH A MISSION Livingstone strongly advises each prospective student to ensure that the following IMMUNIZATIONS are received BEFORE coming to this campus.
1) Injectable or oral Polio vaccine. 2)  Tetanus toxoid injection if last injection was 5 years ago. 3)  Typhoid vaccine. 4) Hepatitis A vaccine x 3 injections. 5) Hepatitis B vaccine x 3 injections. 6) Meningitis vaccine, (yellow fever is often required in neighboring states).

•	TO THE PHYSICIAN: 
The above-named person has applied for admission to a residential educational program of YOUTH WITH A MISSION Livingstone, Zambia. This will require good health and endurance besides sharing rooms with other students. Please fill out the portion below and make any additional comments. Thank you.

Blood Pressure _____Pulse _____ ECG  (Over 40) ____ Visual acuity: (Without glasses) R ____ L ____ (With glasses)  R ____  L ____ Hearing:  R ____   L ____
Are there any abnormalities of the following systems? If so, Please describe fully.
Ears/Nose/Throat/Eyes:___________________________________________________________	
Neurological:___________________________________________________________________
Cardiovascular:_________________________________________________________________
Respiratory:____________________________________________________________________
Musculoskeletal:________________________________________________________________
Endocrine:_____________________________________________________________________
Lymphatic_____________________________________________________________________
Dermatological _________________________________________________________________
Hernia Orifices _________________________________________________________________
Gynaecological_________________________________________________________________
Urological_____________________________________________________________________
Psychiatric ____________________________________________________________________
Would he/she be able to walk 5 - 10 kilometres per day?___________ YES _________  NO.
Additional comments_____________________________________________________________  

•	PHYSICIAN'S RECOMMENDATION:

Acceptable without limitations	__________________________________________________
Acceptable with limitations (Specify) _______________________________________________
Not acceptable_________________________________________________________________
Should remain in areas where adequate medical care is provided _______________________
Physician's name: (Print) ________________________________________________________
Address:______________________________________________________________________
Phone: _______________ Date: __________Physician's signature:______________________

PLEASE MAIL THIS FORM DIRECTLY TO: 

The Registrar, YWAM Livingstone, P. O. Box 60508, Livingstone, Zambia. Tel: +260 21 332 2164, Email: ywamstone@yahoo.com or ywam.livingstone@gmail.com