YWAM Gold Coast DTS Application

Are you applying for *

DTS

When are you planning to arrive? *

MM

DD

YYYY

When are you planning to leave?

MM

DD

YYYY

Name *

First Name

Last Name

Sex *

Male

Female

Birthday

MM

DD

YYYY

Spouses Birthday

Only answer if you answered: Engaged, Married, Remarried, or Widower

MM

DD

YYYY

Will Your spouse be accompanying you?

Only answer if you answered: Engaged, Married, Remarried

Yes

No

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is your permanent address the same as your mailing address?

Yes

No

Physical Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you currently hold an Australian Visa? *

Yes

No

No, I am an Australian, NZ citizen

Visa Expiry Date

MM

DD

YYYY

Do you currently hold a valid Passport? *

Yes

No

Passport Expiry Date

MM

DD

YYYY

Emergency Contact Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Pastor's Name

First Name

Last Name

Have you ever been convicted of a felony? *

Yes

No

Have you ever been convicted of a sexual crime? *

Yes

No

Is English your first Language? *

Yes

No

Have you ever had lectures delivered by a native English speaker?

Yes

No

Have you had a minimum of three (3) years studying English as a foreign language with a pass rate of at least 80%

Yes

No

Have you completed formal independent testing with a minimum level at, or equivalent to, the following: TOEFL: 530 IELTS: 5.0

Yes

No

Are you still attending secondary school?

Yes

No

Do you have a disability, medical condition or impairment? *

Yes

No

Are you able to walk 5km / 3m in a day? *

Yes

No

Can you perform reasonably strenuous work on a daily basis? *

Yes

No

Are you currently under medical supervision? *

Yes

No

Are you presently taking any medication? *

Yes

No

Are you allergic to any drugs or medication? *

Yes

No

Do you have any dietary needs? *

Yes

No

Do you have, or have you ever had any of the following?

Please check, if applicable and explain below

Diabetes

Heart Trouble

High Blood Pressure

Epilepsy

Hepatitis

Cancer/Tumors

HIV

Hay Fever/Asthma

Head Injury

Recurrent Headaches

Back Problems

Depression

Insomnia

Other

How would you rate your overall health condition? *

Excellent

Good

Fair

Poor

Do you have your complete school fees? *

Yes

No

Do you have your complete outreach fees? *

Yes

No

Would you like information about how to raise support? *

Yes

No

Do you have any significant outstanding debts? *

Yes

No

Pastor Reference Name *

First Name

Last Name

Teacher Reference Name *

First Name

Last Name

Friend Reference Name *

First Name

Last Name

How did you find the application process?

Simple

Difficult