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Personal Information

Date of Application:	mm-dd-yyyy	School Date:	Sep 2008 April 2009
Male: Female:
Name:
First:		Middle:		Last:
Email:

Current Address

Street/P.O. Box:		City:		State/Province:
Zip/Postal Code:		Country:		Phone:

Permanent Address

Street/P.O. Box:		City:		State/Province:
Zip/Postal Code:		Country:		Phone:
Fax Number:

Age:	Birthday:	January February March April May June July August September October November December	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31	1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950	Birthplace (City & Country):

Citizenship:		Do you have a Passport? Yes No
Place of Issue:		Date of Expiry:  mm-dd-yyyy

Visa Type (non US):	Place of Issue:
Date of Issue: mm-dd-yyyy	Date of Expiry: mm-dd-yyyy

Marital Status: Single Engaged Divorced Separated Remarried Widowed Married	Anniversary: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950
Spouse's Name:

Names of Children accompanying you:

1.

2.

3.

4.

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Background

Does your Pastor know that you are applying to this school? Yes No

Is he or she in agreement with your plans? Yes No

Pastor's Name:		Church Name:
Church Address:
Street/P.O. Box:		City:		State/Prov:
Zip Code:		Country:		Phone Number:
Church Email:		Denomination:

1234+

How long have you been a "born-again" Christian? 1 2 3 4+

Previous missions experience (Please list when, where, program and leader):

How did you hear of the DTS?

What is your purpose in applying for the DTS?

Occupation:

Please list any occupational skills:

Music ability and other talents:

Highest level of education completed:  some high school GED high school diploma some college associate's bachelor's master's doctorate

Languages: (list in order of proficiency)

Financial Information

Do you have your complete school fees?  Yes No

If no, from what source will they come from?

Do you have any outstanding debts?  Yes No

If yes please explain:

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I certify that this information is complete and accurate.

Name:  Date: mm-dd-yyyy

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Youth With A Mission Atlanta
P.O. Box 1025 Grayson, GA 30017

info@ywamatlanta.org