GUIDE TO COMPLETING PARTICIPANT APPLICATION

NOTE: While sending the application back to us, please remove this front page –
this is to ensure that you fill out the form completely & accurately.
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Thank you for applying to the U of N Training School with U of N – Lonavala!

The following application may seem long, but take courage, every question is there for a reason.
It is an important step for you to apply for this school and serve in a ministry setting during the
outreach phase (which is, part of the course) and hopefully longer.
We, as facilitators, need to know this information so that we can help you develop God’s call on
your life.
Since we are all learning, our STUDENTS are referred to as ‘participants’ with us, and we, the
STAFF are referred to as ‘facilitators’ for our learning together, as a family.
 If a question does not apply to you, write N/A in the blank space provided for your answer.
 Husbands and wives both enrolling as students must complete separate applications.

In order for us to process your application, we must receive ALL of the following, so please
CHECK (), as you complete these, so you don’t miss out on any of the required forms:

 1) Participant Application form – all sections completed

 2) Photographs – one recent photograph of yourself to be attached with the application.

 3) Reference forms – the three forms need to be given to the following people:
i) your Pastor (please give the Pastor’s reference form)
ii) most recent U of N / YWAM leader (if, you are applying to U of N course for
the first time, then ask your most recent employer to fill this out)
iii) a friend (not a family member), who will give an honest evaluation about
you.

List the names and addresses of your three references in the space provided on the
PARTICIPANT APPLICATION FORM – Section: M
These completed reference forms must be posted or e-mailed directly to U of N Pune by
the persons providing these confidential references and NOT by yourself. Your
application cannot be processed until the U of N Pune Registrar receives all reference
forms.

 4) Specific questions – Besides this general ‘participant application’, each training

program have their own specific questions – please answer that questionnaire as well, as
those questions deal specifically for the school you are applying now.

HOW TO SUBMIT APPLICATION FORMS ?

If sending by ‘snail mail’ (post), then please send it to:

The Registrar, UofN - Pune,
(write the name of school applying for – eg: DTS, SBS, etc.)
C/o asha seva kendra old khandala rd H-58 lonavala pune 410401
Alternatively, if you are e-mailing, our e-mail address is
admissions@[Link]
 PARTICIPANT APPLICATION

School applied for: ______________________________ School start date: _____________

SECTION – A PERSONAL INFORMATION

Name of applicant (as it appears in your passport): ____________________________________
(Family name / Surname)

_____________________________________________ ______________________________
(First, Middle & Other names) (Preferred Name)

Date of Birth (dd/mm/yy): _____/_____/_______ ** Male / Female (circle one)

Country of Citizenship: ________________________________________________

Address for communication: _____________________________________________________

Street / P.O. Box City

_________________________________________ Phone: ___________________

State / Prov. Zip (Postal) Code COUNTRY (include Country & Area code)

E-mail: ________________________________________ Fax : ____________________

Marital status (circle whatever is appropriate): Single / Engaged / Separated / Widowed /

Married / Divorced / Remarried
Give date of most recent change in status, if any: ________________________________

Name of Spouse (if married): ______________________________________________________

Age: ____ yrs. Birth place & Country of Citizenship: ___________________________

List of children (or) dependents (child’s teacher or nanny), accompanying the applicant:

i) ____________________________________________________________________________
Name Age Sex Who? Class in School (if studying)

ii) ____________________________________________________________________________
Name Age Sex Who? Class in School (if studying)

iii) ___________________________________________________________________________
Name Age Sex Who? Class in School (if studying)

Language proficiency – List the languages you speak in decreasing order of fluency:

(i) _______________________ (ii) _______________________ (iii) ____________________

SECTION – B EDUCATION

List all your educational/professional training you’ve had (including YWAM’s U of N training):
Name of Course Where When Completed?

1) ___________________________________________________________________________

2) ___________________________________________________________________________

3) ___________________________________________________________________________

4) ___________________________________________________________________________

5) ___________________________________________________________________________

SECTION – C EMPLOYMENT

List all work experiences you’ve had (including YWAM’s U of N, if any):

Jobs Where Position held Period

1) ___________________________________________________________________________

2) ___________________________________________________________________________

3) ___________________________________________________________________________

4) ___________________________________________________________________________

5) ___________________________________________________________________________

*** NOTE-1: Please give one of your reference forms to your most recent Supervisor / Leader

List any special talents / skills or work related abilities:

(i) ____________________________________ (ii) _________________________________

(iii) ____________________________________ (iv) _________________________________

(v) ____________________________________ (vi) _________________________________

SECTION – D HOME CHURCH INFORMATION
1) Name of Church: ____________________________________________________________

2) Affiliation of Church / Denomination: ___________________________________________

3) Name of your Pastor: _______________________________________

4) Church contact details (E-mail, phone and/or fax): __________________________________

________________________________________________________________________

5) Are you accountable to someone in this Church? ___________________________________

6) If so, to whom and in what way? ________________________________________________

________________________________________________________________________

SECTION – E FINANCIAL INFORMATION

1) Do you have your complete school fee? YES / NO
If NO, how do you plan to pay the amount? Please be specific (Answers such as: ‘God will
provide’ or ‘family might help’ are not sufficient): ____________________________________
______________________________________________________________________________
______________________________________________________________________________

2) Do you have any outstanding debts? YES / NO

If YES, then explain, how do you plan to pay that amount? ___________________________
______________________________________________________________________________
______________________________________________________________________________

ACKNOWLEDGMENT OF FINANCIAL RESPONSIBILITY:

I understand that payment of the required school tuition fees must be made prior to or upon my
arrival, unless otherwise approved in writing by the School Director / Leader before my arrival.
Further, I agree to meet in a timely manner, prior to the completion of School, all personal
expenses incurred during my involvement with U of N - Pune.
If, I am accepted by U of N - Pune, I will abide by the Spirit, rules and schedule of the school.

Applicant’s Name : _________________________________________________

Signature : _________________________________Date : _____/_____/20_____

SECTION – F HEALTH & EMERGENCY INFORMATION
1) In case of emergency, please contact:
Name : ___________________________________________

Relationship to you : _________________________________

Address : ____________________________________________________________________
Street / P.O. Box City

__________________________________________ Phone: ___________________

State / Prov. Zip (Postal) Code COUNTRY (include Country & Area code)

E-mail: ______________________________________ Fax : ____________________

2) Do you have another person whom we could contact, in an emergency?

Name : ___________________________________________

Relationship to you : _________________________________

Address : ____________________________________________________________________
Street / P.O. Box City

__________________________________________ Phone: ___________________

State / Prov. Zip (Postal) Code COUNTRY (include Country & Area code)

E-mail: ______________________________________ Fax : ____________________

PERSONAL EMERGENCY INFO:
Blood Type (O, A, B, AB)? _________________ Rh factor (+/-): ___________________

Are you allergic to any drugs or medications? YES / NO

If YES, please specify: ___________________________________________________________

_____________________________________________________________________________

Do you have Medical Insurance? YES / NO

If YES, name of insurer? ________________________________ Policy #: ________________

Describe type and extent of coverage : _______________________________________________

YOUR DOCTOR’S DETAILS:

Name : ___________________________________________

Address : ______________________________________________________________________
Street / P.O. Box City

_____________________________________________ Phone : __________________

State / Prov. Zip (Postal) Code COUNTRY (include Country & Area code)

E-mail: ______________________________________ Fax : ____________________

SECTION – G PERSONAL MEDICAL HISTORY
Please answer all questions.

1) Are you presently under a doctor’s care for any condition : YES / NO
If YES, please specify : _______________________________________________________
__________________________________________________________________________
__________________________________________________________________________

2) Are you taking any medication at this time? YES / NO

If YES, please specify : _______________________________________________________
__________________________________________________________________________
__________________________________________________________________________

3) Can you eat spicy foods? YES / NO

Please comment : ____________________________________________________________
__________________________________________________________________________

4) Have you ever received compensation for disability? YES / NO

If YES, please specify : _______________________________________________________
_________________________________________________________________________________

5) Do you have any physical impairments, handicaps or health conditions which require special

attention? YES / NO. If YES, please specify (your response to this question will not

effect your admission consideration): ___________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

6) Were the results of your last medical check-up normal? YES / NO

If NO, give details. Is your physician aware of you travelling to Pune. Does he have any
hesitation on your travelling for any reason. If so, WHY? __________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________
7) Rate your health condition: EXCELLENT / GOOD / FAIR / POORLY

Have you ever had, or do you have any of the following? For each YES answer, please include
an explanation, on a separate piece of paper, giving more details:

TYPE OF DISEASE YES / NO TYPE OF DISEASE YES / NO

Skin Conditions Venereal Disease
Heart Trouble Stomach / Duodenal Ulcer
Recurrent Diarrhea Tumor / Cancer
Eye Trouble Fainting Spells
Ear Trouble Gall Bladder Problems
Diabetes Paralysis
High Blood Pressure Depression
Low Blood Pressure Mental or Nervous Disorder
Kidney Disease Insomnia
Head Injury HIV / AIDS
Rheumatism / Arthritis Hay Fever / Asthma
Anaemia Drug Addiction
Recurrent Headache Appendectomy
Back Problems Jaundice / Hepatitis
Epilepsy Any kind of surgery
Any kind of Allergies Any other illnesses or conditions

NOTE: The U of N kitchen is NOT equipped to prepare special diets. Food/additive allergies
must be documented by a letter from your physician AND a licensed/registered clinical dietician.

FOR FEMALES ONLY:

Irregular periods : YES / NO
Severe Cramps : YES / NO
Excessive flow : YES / NO
Are you pregnant? : YES / NO
If YES, expected date of delivery: ____/____/20___

SECTION – H COMMUNICABLE DISEASES

Have you had any of the following? If your answer is YES, for any one of the following,
please give details on a separate sheet of paper.

TYPE OF DISEASE YES / NO TYPE OF DISEASE YES / NO

Chicken pox Measles (Rubeola)
Scarlet fever Measles (Rubella or German Measles)
Mumps Pertussis (Whooping cough)
Tuberculosis Other disease
SECTION – I FAMILY HISTORY
Has any of your family members or near relatives had any of the following? If YES, please name
the person by relationship – ie: parent, siblings, uncles, etc.

TYPE OF DISEASE YES NO RELATIONSHIP TO YOU

Tuberculosis
Arthritis
Diabetes
Stomach Disease
Kidney Disease
Asthma / Hay Fever
Heart Disease
Epilepsy / Convulsions
Hypertension
Cancer
Other illness (specify: ______________)

SECTION – J IMMUNISATIONS
Applicants are strongly recommended to be up to date on the following immunisations.
List which immunisations you have received so far:

TYPE OF INJECTION / SERIES DATE OF LAST

YES / NO
BOOSTER COMPLETED INJECTION / BOOSTER
DPT
Tetanus
MMR
Typhoid
Hepatitis – A
Hepatitis – B
Other (specify: ___________)

SECTION – K CONSENT FOR TREATMENT

In case of emergency, I hereby agree to the performance of such treatment, including anesthesia
and surgery, as the attending doctor or physician may deem necessary, at my cost.
NOTE: (If sending this application by e-mail, then you may write a note,
stating that you consent and that you will sign upon arrival here).

Applicant’s Name : _________________________________________________

Signature : __________________________________ Date : _____/_____/20_____

SECTION – L PERSONAL HISTORY
Prayerfully answer the following questions on a separate sheet of paper (just write down the
number, you don’t have to re-write the questions again.
You must do this without any help from others. Try to be specific while answering.

1. Describe your spiritual and/or ministry goals, including missionary service goals.

2. Do you have a long-term missions call? If so, how will this particular school help you to
reach your goals? If no, give reasons for applying for this course.

3. Describe how you have been involved with your local church. Include details of
ministries you were involved in – length of involvement and your role in the ministry.
Also include details of any leadership roles.

4. Describe any business professional, mission or other significant experiences.

5. What most influenced your decision to apply for this course?

6. Describe your relationship with your family (please give a detailed response).

7. How does your family feel about your participation with the UofN training program?

8. Have you discussed your calling and application for this school with your Pastor? How
does your Pastor feel about it (please give details)

9. Is your church willing to support you with prayer? Is your church willing to support you
with finances? If yes, to what extent?

10. Is there any other information that you feel would be helpful in processing your
application? Eg. Children’s schooling if necessary. How do you feel your children will
cope with the move, ie: climate, culture, food, society, and education?

SECTION – M PERSONAL REFERENCES

Please provide the following information on your three personal referees and make sure you pass
on the enclosed ‘reference forms’ to those concerned:

REFERENCE – 1 REFERENCE - 2
Name : ________________________________ Name : ________________________________
Relationship : __________________________ Relationship : __________________________
Address : ______________________________ Address : ______________________________
_____________________________________ _____________________________________
_____________________________________ _____________________________________
_____________________________________ _____________________________________

REFERENCE – 3
Name : ________________________________
Relationship : __________________________
Address : ______________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
SECTION – N DECLARATION & RELEASE OF LIABILITY

DECLARATION

I, ________________________________________, the applicant, declare the information I have

provided on the application forms is correct, and all questions have been answered truthfully. I
understand that U of N reserves the right to take necessary disciplinary action, including my being
dismissed from the course / school, if any information(s) provided by me is found to be untrue.

NOTE: (If sending this application by e-mail, then you may write a note,
stating that you consent and that you will sign upon arrival here).

Applicant’s Name : _________________________________________________

Signature : ___________________________________Date : _____/_____/20_____

RELEASE OF LIABILITY

I, __________________________________________, do hereby release YWAM / U of N, its

staff, agents and volunteer assistants from any liability whatsoever arising out of an injury,
damage or loss which may be sustained by said person during the course of involvement with the
U of N, Pune.

NOTE: (If sending this application by e-mail, then you may write a note,
stating that you consent and that you will sign upon arrival here).

Applicant’s Name : _________________________________________________

Signature : ___________________________________ Date : _____/_____/20_____