NEW MB APP - YWAM Maui

Guide To Completing
The Mission Builder
Application
We want to thank you for your interest in our Mission Builder program! We pray God will give you
wisdom and guidance as you fill out this application. If you have any questions, please contact us. Thank you for
considering YWAM Maui in your future plans. God bless!
HOW TO COMPLETE THIS APPLICATION:
All of the following forms must be submitted with all applicable questions answered before a decision will
be made. If a question does not apply, write “N/A” in the space provided. Husbands and wives enrolling as
mission builders must complete separate application forms. If you need more space to answer a question, please
use a separate sheet of paper.
REFERENCES:
Enclosed with this application are two reference forms, which need to be sent to the references that you
have selected (one friend, and one spiritual leader). Fill in your name, address, and the dates you’re applying
for, and then give the forms to two references. Please ask that they return the forms directly to us in a sealed
envelope, as soon as possible.
ADMINISTRATION FEE:
A non-refundable fee of $70.00 US (which covers the cost of processing your application) must be
included when you return this form.
UPON RECEIPT OF THE COMPLETED (INCLUDING PHOTOS AND REGISTRATION FEE) APPLICATION AND
REFERENCES, YOUTH WITH A MISSION - MAUI WILL PRAYERFULLY CONSIDER THE APPLICATION AND
NOTIFY THE APPLICANT OF THEIR DECISION.
CHECKLIST:
_____Application Form
_____Personal History
_____Waiver of Liability
_____Guidelines and Requirements
_____Health Form
_____Photos (2 Passport-Style Photos)
_____Registration Fee: $70 USD per individual - $100 USD for married couples
_____Reference Forms
_____Pastor/Spiritual Leader
_____Friend
Please direct all forms and
correspondence to:
Youth With A Mission - Personnel
PO Box 790237
Paia, Maui - HI
96779
Toll Free: 1-866-579-8402
Fax: (808) 575-9476
Email: [email protected]
Mission Builder
Confidential Application Form
1) PERSONAL INFORMATION:
Please include a
recent photo
with this
application.
DATE APPLYING FOR:_______________________
NAME: ________________________________________________________________________________________________________________
(Title, First Name, Last Name)
PERMANENT ADDRESS: _______________________________________________________________________________________________
_______________________________________________________________________________ COUNTRY: _____________________________
(Street/Box #, City, State/Province, Zip/Postal Code, Country)
CURRENT MAILING ADDRESS (If different than above): VALID UNTIL: _________________________________________
________________________________________________________________________________________________________________________
_______________________________________________________________________________ COUNTRY: _____________________________
PHONE: ________________________ FAX: _______________________________ EMAIL: ________________________________________
DATE OF BIRTH: (mm/dd/yy): ________/________/________
AGE: _________
GENDER: M ________
F__________
ARE YOU FLUENT IN ENGLISH? ________________________
2) MARITAL STATUS:
_____SINGLE
_____ENGAGED
_____DIVORCED
_____SEPARATED
_____REMARRIED
_____MARRIED
_____WIDOWED
NAME OF SPOUSE: _____________________________________________________________________________________________________
AGE: _______________________ BIRTH DATE: ________________________
DO YOU HAVE CHILDREN?: __________ IF YES, PLEASE LIST THEIR NAME, AGE, & GENDER BELOW.
NAME: _______________________________________ AGE: _______________________ GENDER: ________________________________
NAME: _______________________________________ AGE: _______________________ GENDER: ________________________________
NAME: _______________________________________ AGE: _______________________ GENDER: ________________________________
3) HOW DID YOU HEAR ABOUT THIS BASE?:
____________________________________________________________________________
________________________________________________________________________________________________________________________
DO YOU HAVE ANY FRIENDS THAT ARE ALSO APPLYING FOR OUR MISSION BUILDING PROGRAM? _______________________
________________________________________________________________________________________________________________________
4) CHURCH INFORMATION:
NAME: ___________________________________________________
MAILING ADDRESS: (Street/PO Box #, City, State/Province, Zip/Postal Code,Country) _____________________________________
________________________________________________________________________________________________________________________
PASTOR’S NAME (Title & Name): _______________________________________________________________________________________
5) EDUCATION & SKILLS:
A) PREVIOUS YWAM PROGRAMS/SCHOOLS ATTENDED:
SCHOOL/PROGRAM
LOCATION
OUTREACH DESTINATION
DATES ATTENDED
___________________
________________ __________________________ __________________
___________________
________________ __________________________ __________________
B) OCCUPATIONS/JOB EXPERIENCE:
OCCUPATION/TITLE:
LOCATION
________________________________ _________________
__________________________
________________________________ _________________
__________________________
C) PERSONAL SKILLS:
PROFESSIONAL LICENSES/QUALIFICATIONS: ___________________________________________________________________
D) AREAS WHERE YOU HAVE WORK EXPERIENCE OR QUALIFICATIONS:
LENGTH OF EMPLOYMENT
MUSICAL/OTHER TALENTS: ____________________________________________________________________________________
LANGUAGES: __________________________________________________________________________________________________
(If English is your second language, you will need to fill out an “English Language Questionnaire”)
______ MAINTENANCE ______CONSTRUCTION ______COOK/KITCHEN
______ VEHICLE MAINTENANCE
______ART (GRAPHICS)
______HOUSEKEEPING
______YARD MAINTENANCE
______HOSPITALITY
______COMPUTER/OFFICE
WHAT AREAS DO YOU PREFER TO WORK IN?: _______________________________________________________________________
________________________________________________________________________________________________________________________
DO YOU HAVE DIFFICULTY WALKING UPHILL, STANDING FOR LONG PERIODS OF TIME, OR WORKING IN THE
SUN?:
________________________________________________________________________________________________________________________
Please return to:
YWAM Maui - Personnel
PO Box 790237
Paia, Maui - Hawaii
96779
USA
Mission Builder
Health Form
BASIC INFO: DATE APPLYING FOR: ____________________________
NAME OF APPLICANT: _________________________________________________________________________________________________
MAILING ADDRESS (Street/Box #, City, State/Prov, Zip/Postal Code): ____________________________________________________
___________________________________________________________________ COUNTRY: _________________________________________
PHONE: ______________________________ FAX: _______________________________ EMAIL: ___________________________________
DATE OF BIRTH (mm/dd/yy): _____/_____/_____ SOCIAL SECURITY #: ___________________________________
PERSON TO CONTACT IN CASE OF EMERGENCY:
NAME OF CONTACT: ___________________________________________________________________________________________________
MAILING ADDRESS (Street/Box #, City, State/Prov, Zip/Postal Code): _____________________________________________________
___________________________________________________________________ COUNTRY: _________________________________________
PHONE: ______________________________ FAX: _______________________________ EMAIL: ___________________________________
MEDICAL INSURANCE (REQUIRED BY YWAM MAUI):
NAME OF INSURER: ______________________________________ MEDICAL INSURANCE #: ____________________________________
PERSONAL HISTORY:
HEIGHT: _________________ WEIGHT: __________________ BLOOD TYPE: ____________________
YOU WOULD RATE YOUR HEALTH CONDITION AS: _______EXCELLENT
_______GOOD
_______FAIR
_______POOR
HAVE YOU EVER BEEN INVOLVED, WITH THE FOLLOWING? IF YES - EXPLAIN, AND LIST MOST RECENT DATES OF USE.
ALCOHOL: _____________________________________________________________________________________________________________
SMOKING: _____________________________________________________________________________________________________________
ILLEGAL DRUGS: ______________________________________________________________________________________________________
HAVE YOU EVER HAD ANY OF THE FOLLOWING COMMUNICABLE DISEASES?
YES
NO
YES
NO
YES
NO
CHICKENPOX
MUMPS
TUBERCULOSIS
MEASLES (RUBELLA)
PERTUSSIS
OTHER (SPECIFY)
MEASLES (RUBEOLA)
SCARLET FEVER
HAVE ANY OF YOUR RELATIVES EVER HAD ANY OF THE FOLLOWING?
YES
NO
YES
NO
YES
NO
TUBERCULOSIS
HEART DISEASE
STOMACH DISEASE
DIABETES
HYPERTENSION
EPILEPSY
KIDNEY DISEASE
ARTHRITIS
CANCER
PLEASE ANSWER ALL QUESTIONS. COMMENT ON ALL “YES” ANSWERS IN THE SPACE BELOW, OR ON A SEPARATE SHEET OF PAPER. HAVE YOU EVER HAD ANY OF THE FOLLOWING?:
YES
NO
YES
NO
Skin Conditions
Eye Trouble
Ear Trouble
Head Injury
Recurrent Headaches
Epilepsy
Fainting Spells
Mental Disorders
Nervous Disorders
Paralysis
Insomnia
Shortness of Breath
Hay Fever/Asthma
Allergies (specify)
YES
NO
Heart Trouble
High Blood Pressure
Low Blood Pressure
Arthritis
Back Problems
Dislocation of Joint
Tumor/Cancer
Stomach Ulcer
Gall Bladder Problems
Surgery
Appendectomy
Tonsillectomy
Hernia Repair
Other (specify)
Jaundice
Hepatitis
Intestinal Trouble
Recurrent Diarrhea
Diabetes
Kidney Disease
Anemia
Venereal Disease
A.I.D.S.
FEMALES ONLY
Irregular Periods
Severe Cramps
Excessive Flow
Are you pregnant?
IF YES PLEASE EXPLAIN: ____________________________________________________________________________________________
IMMUNIZATIONS (Basic Booster and most recent):
YEAR
YEAR
YEAR
YEAR
YEAR
YEAR
Tetanus
ARE YOU CURRENTLY UNDER A DOCTOR OR
HEALTH CARE PROFESSIONAL’S CARE FOR ANY
CONDITION?
Pertussis
______YES ______NO
Diphtheria
Polio
IF YES, PLEASE EXPLAIN: _________________________
Rubella
Rubeola
____________________________________________________
Mumps
PLEASE LIST ANY MEDICATIONS YOU ARE CURRENTLY TAKING:
Hep A
Hep B
____________________________________________________
Tetanus
____________________________________________________
Typhoid
CONSENT FOR TREATMENT
In case of emergency, I/we hereby agree to the performance of such treatment including anesthesia and surgery as the
attending doctor or physician may deem necessary.
___________________________________
(Applicant’s Name Printed) ___________________________________
(Parent or Guardian of those under 18)
_____________________________
(Applicant’s Signature) ___________________________________
(Date)
_____________________________
(Parent or Guardian Signature)
___________________________________
(Date)
Please return to:
YWAM Maui - Personnel
PO Box 790237
Paia, Maui - Hawaii
96779
USA
Mission Builder
Waiver Of Liability & Release
DATE APPLYING FOR: _______________________
I, the undersigned, individually hereby release YOUTH WITH A MISSION (herein after YWAM),
it’s staff, agents, employees, and representatives, from all claims, causes of action or lawsuits relating
to or resulting from activities or events involving YWAM. I hereby acknowledge and agree that I am
personally aware of all risks associated with or related to missions work, sporting events, training,
traveling, interaction with foreign people and nations and all activities which are part of the YWAM
program. I agree to assume all risk of injury or loss that may occur or be related to in any other manner to YWAM or the activities I may engage in while with YWAM.
This Release shall apply to all claims for physical and/or mental injury, attorney’s fees, costs
and expenses of litigation, claims for loss of consortium, medical expenses, loss of earning, punitive
damages, and all other claims whatsoever, which may result from or be in any manner related to
YWAM.
I further promise to agree to indemnify, defend, and forever hold harmless YWAM, it’s staff,
agents, employees, and representatives against all claims, actions, cross-claims, or third-party claims
arising from or ins any manner related to YWAM - whether such actions are brought by third-party
claims arising from or in any manner related to YWAM or whether such actions are brought by third
parties or anyone acting on behalf of myself.
In the event that YWAM files any action to enforce the provisions, releases and covenants of
this agreement, YWAM shall be entitled to all reasonable attorney’s fee and costs of such enforcement
proceeding.
BY SIGNING THIS RELEASE, IN UNDERSTAND THAT I AM RELEASING ALL
CLAIMS FOR INJURY OR DAMAGE.
_________________________________________
Date: ______/______/______
_________________________________________
Date: ______/______/______
(PARENT OR LEGAL GUARDIAN IF APPLICANT IS UNDER 18 YEARS OF AGE) (APPLICANT’S SIGNATURE)
(MM/DD/YY)
(MM/DD/YY)
Mission Builder
Personal History
PRAYERFULLY ANSWER THE FOLLOWING QUESTIONS IN THE SPACE PROVIDED.
PLEASE TYPE OR PRINT IN ENGLISH.
1) HOW LONG HAVE YOU BEEN A COMMITTED CHRISTIAN?: ________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
2) DESCRIBE YOUR CONVERSION EXPERIENCE: ____________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
3) DESCRIBE YOUR PRESENT WALK WITH GOD: ____________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
4) DESCRIBE THREE AREAS THAT YOU ARE SEEKING TO GROW IN OR IMPROVE ON DURING THIS TIME:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
5) DESCRIBE THE MINISTRIES THAT YOU ARE CURRENTLY INVOLVED IN: __________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
6) DO YOU HAVE A SPECIFIC CALL TO LONG-TERM SERVICE AT SOME POINT? EXPLAIN: _____________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
7) DESCRIBE YOUR RELATIONSHIP WITH YOUR LOCAL CHURCH: ___________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
8) DESCRIBE YOUR HOME/FAMILY RELATIONSHIPS: _______________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Please return to:
YWAM Maui - Personnel
PO Box 790237
Paia, Maui - Hawaii
96779
USA
Mission Builder
Guidelines & Requirements
THE FOLLOWING INFORMATION IS PROVIDED SO THOSE PROSPECTIVE MISSION BUILDERS WILL BE
AWARE OF THE GUIDELINES AND REQUIREMENTS FOR YWAM MAUI PERSONNEL (STAFF, MISSION
BUILDERS, AND STUDENTS). PLEASE READ THROUGH THE WHOLE PAGE BEFORE SIGNING YOUR
NAME.
QUALITY OF WORK: We need people who will do their best at whatever job they are assigned. As a YWAM community, we
need everyone to be good stewards of community property, taking care of things as if it were personally their own.
HOUSEKEEPING: Each person is expected to maintain their living space neatly so that community housing is kept looking
nice and not offensive to others.
ATTITUDE: A good attitude is essential to working and living in a community setting. We expect each person to have a
teachable attitude so that we can all learn and grow together in the Lord. A loyal and submissive attitude towards those in
authority is also important.
QUIET TIMES: Our personal relationship with Jesus Christ must remain the most important thing in our lives if our work
here is to be successful. Therefore, we expect each person to maintain the daily discipline of seeking God and making the
quiet devotional times a priority. As a YWAM community, our daily rising time is 7am to help people have alone with the Lord
before the day begins.
EXCELLENCE: We at YWAM-Maui are committed to excellence and we want people who are serious about serving God. We
strive towards excellence in our work, our relationships and in our personal lives.
DRESS: Each person will be sensitive to his or her wardrobe and attire while here on the base. It is essential that you recognize how you dress reflects your respect for those around you.
PERSONAL CONDUCT: The person will not indulge in tobacco products or drinking alcoholic beverages. We are trying to
establish a Godly reputation in our small town and need to maintain a high level of personal holiness.
I AGREE WITH THESE GUIDELINES AND AGREE TO ABIDE BY THEM DURING MY STAY AT YWAM MAUI.
_________________________________________
Date: ______/______/______
_________________________________________
Date: ______/______/______
(PARENT OR LEGAL GUARDIAN IF APPLICANT IS UNDER 18 YEARS OF AGE) (APPLICANT’S SIGNATURE)
(MM/DD/YY)
(MM/DD/YY)
Mission Builder
Pastor/Spiritual Leader
Confidential Reference Form
Name of applicant:_________________________________________________ Date of School Applying For: _____________________
Street/Box #: __________________________________ City: _______________________________ State/Province: _________________
Zip/Postal Code: _________________ Country: _____________________ Phone: ____________________ Email: __________________
*I/We the above mentioned applicant, waive any right I have to read or obtain copies of this recommendation, knowing
that this is not required as a condition for admission.
APPLICANT’S SIGNATURE: _______________________________________________ DATE: ___________________________________
The applicant named above has applied for admission to one of Youth With A Mission’s ministries. YWAM is an International
movement of Christians from many denominations dedicated to presenting Jesus Christ to this generation, to mobilizing as
many as possible to help in this task and to the training and equipping of believers for their part in fulfilling the Great
Commission. In order to adequately evaluate the applicant for admission, we would appreciate your supplying the
information requested on this form. Your statement will help us to effectively meet the needs of the applicant should he/she
be accepted into the program applied for. It is therefore not in the applicant’s best interest to give an unrealistically positive
view of them. An honest, realistic appraisal of the challenges they will face will help, rather than hinder their application. If
you would prefer to give your opinions by telephone, please feel free to do so.
1. How long have you known the applicant? _____________________________________________________________________________
2. On a scale of 1 to 10, how well do you feel you know the applicant? (1 being very little, 10 being intimately)
Circle one:
1
1
3
4
5
6
7
8
9
10
3. Please check which word would best describe the applicant in the following areas:
Superior
Above Average
Average
Below Average
Inferior
Initiative
Social Adaptability
Concern For Others
Ability To Follow
Leadership
Decision Making
Emotional Stability
Health
Personal Appearance
Comments: ____________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
4. Please describe in your own words how you would rate the applicant in the following areas:
Health __________________________________ Mental Ability ________________________________________
Initiative
__________________________________ Social Adaptability
________________________________________
Reliability
__________________________________ Ability to cope with stress ______________________________________
Personal appearance _____________________________
Cooperation
________________________________________
Concern for others _______________________________
Self discipline
________________________________________
Leadership
Christian character
________________________________________
Emotional stability _______________________________ Temperament ________________________________________
Ability to follow __________________________________ Punctuality
________________________________________
Flexibility
Perseverance
________________________________________
__________________________________ __________________________________ 5. To what extent is the applicant active in church work?: ________________________________________________________________
________________________________________________________________________________________________________________________
6. Does he/she display high moral standards? ______ Yes ______ No
If no, please explain: ___________________________________________________________________________________________________
________________________________________________________________________________________________________________________
7. Is he/she prejudiced against any groups, races, or nationalities?: ______ Yes ______ No
If yes, please explain: ___________________________________________________________________________________________________
________________________________________________________________________________________________________________________
8. With reference to his/her Christian service, which word best describes the applicant?
_____ Dedicated ______ Average ______ Casual
Please explain: _________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
9. In your consideration, which of the following would best describe the applicant’s overall Christian experience?:
______ Mature
______ Contagious
______ Genuine & Growing
______ Superficial
Comments: ____________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
10. Overall, what do you consider to be the applicant’s strong points?: ____________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
11. Please comment briefly on the applicant’s family background (if known): ______________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
12. In your opinion, what are the applicant’s motives for applying to YWAM?: _____________________________________________
________________________________________________________________________________________________________________________
13. Would you recommend the applicant for acceptance by Youth With A Mission: __________________________________________
________________________________________________________________________________________________________________________
14. Is there anything else we should know about the applicant?: __________________________________________________________
________________________________________________________________________________________________________________________
I declare that the contents of this reference are correct to the best of my knowledge.
NAME: ___________________________________________________ RELATION: _______________________________________________
STREET/BOX #: ___________________________________________________________ CITY: ____________________________________
STATE/PROVINCE: __________________ ZIP/POSTAL CODE: _________________________ COUNTRY: _________________________
PHONE: ___________________________ FAX: _____________________________ EMAIL: _______________________________________
SIGNATURE: _________________________________________________________ DATE: ________________________________________
Please send this completed form in a sealed envelope to:
Personnel - YWAM Maui
PO Box 790237
Paia, Maui - HI
96779 - USA
Mission Builder
Friend
Confidential Reference Form
Name of applicant:_________________________________________________ Date of School Applying For: _____________________
Street/Box #: __________________________________ City: _______________________________ State/Province: _________________
Zip/Postal Code: _________________ Country: _____________________ Phone: ____________________ Email: __________________
*I/We the above mentioned applicant, waive any right I have to read or obtain copies of this recommendation, knowing
that this is not required as a condition for admission.
APPLICANT’S SIGNATURE: _______________________________________________ DATE: ___________________________________
The applicant named above has applied for admission to one of Youth With A Mission’s ministries. YWAM is an International
movement of Christians from many denominations dedicated to presenting Jesus Christ to this generation, to mobilizing as
many as possible to help in this task and to the training and equipping of believers for their part in fulfilling the Great
Commission. In order to adequately evaluate the applicant for admission, we would appreciate your supplying the
information requested on this form. Your statement will help us to effectively meet the needs of the applicant should he/she
be accepted into the program applied for. It is therefore not in the applicant’s best interest to give an unrealistically positive
view of them. An honest, realistic appraisal of the challenges they will face will help, rather than hinder their application. If
you would prefer to give your opinions by telephone, please feel free to do so.
1. How long have you known the applicant? _____________________________________________________________________________
2. On a scale of 1 to 10, how well do you feel you know the applicant? (1 being very little, 10 being intimately)
Circle one:
1
1
3
4
5
6
7
8
9
10
3. Please check which word would best describe the applicant in the following areas:
Superior
Above Average
Average
Below Average
Inferior
Initiative
Social Adaptability
Concern For Others
Ability To Follow
Leadership
Decision Making
Emotional Stability
Health
Personal Appearance
Comments: ____________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
4. Please describe in your own words how you would rate the applicant in the following areas:
Health __________________________________ Mental Ability ________________________________________
Initiative
__________________________________ Social Adaptability
________________________________________
Reliability
__________________________________ Ability to cope with stress ______________________________________
Personal appearance _____________________________
Cooperation
________________________________________
Concern for others _______________________________
Self discipline
________________________________________
Leadership
Christian character
________________________________________
Emotional stability _______________________________ Temperament ________________________________________
Ability to follow __________________________________ Punctuality
________________________________________
Flexibility
Perseverance
________________________________________
__________________________________ __________________________________ 5. To what extent is the applicant active in church work?: ________________________________________________________________
________________________________________________________________________________________________________________________
6. Does he/she display high moral standards? ______ Yes ______ No
If no, please explain: ___________________________________________________________________________________________________
________________________________________________________________________________________________________________________
7. Is he/she prejudiced against any groups, races, or nationalities?: ______ Yes ______ No
If yes, please explain: ___________________________________________________________________________________________________
________________________________________________________________________________________________________________________
8. With reference to his/her Christian service, which word best describes the applicant?
_____ Dedicated ______ Average ______ Casual
Please explain: _________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
9. In your consideration, which of the following would best describe the applicant’s overall Christian experience?:
______ Mature
______ Contagious
______ Genuine & Growing
______ Superficial
Comments: ____________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
10. Overall, what do you consider to be the applicant’s strong points?: ____________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
11. Please comment briefly on the applicant’s family background (if known): ______________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
12. In your opinion, what are the applicant’s motives for applying to YWAM?: _____________________________________________
________________________________________________________________________________________________________________________
13. Would you recommend the applicant for acceptance by Youth With A Mission: __________________________________________
________________________________________________________________________________________________________________________
14. Is there anything else we should know about the applicant?: __________________________________________________________
________________________________________________________________________________________________________________________
I declare that the contents of this reference are correct to the best of my knowledge.
NAME: ___________________________________________________ RELATION: _______________________________________________
STREET/BOX #: ___________________________________________________________ CITY: ____________________________________
STATE/PROVINCE: __________________ ZIP/POSTAL CODE: _________________________ COUNTRY: _________________________
PHONE: ___________________________ FAX: _____________________________ EMAIL: _______________________________________
SIGNATURE: _________________________________________________________ DATE: ________________________________________
Please send this completed form in a sealed envelope to:
Personnel - YWAM Maui
PO Box 790237
Paia, Maui - HI
96779 - USA