Personal Information

Sex *
Do you have a visa to visit the United States? *
Have you Ever Been Denied a Passport or Visa? *
Have you ever been convicted, imprisoned, or been on probation or parole? *
Have you ever been indicted or convicted of a sexual crime? *


Levels Completed *
Have you ever studied English? *
Have you ever been involved in Youth With A Mission Before? *

Supplemental Question

How did you hear about our ESL program? *
What are your main purposes for coming to the United States? *
Why do you want to learn conversational English? *
Are you able to pay for the training? *
Do you go to church in your country? *
Acknowledgment of Responsibility:
I understand that payment of the required school tuition fees must be made in U.S. currency prior to or upon my
arrival. Further, I agree to meet in a timely manner, prior to the completion of school, all expenses incurred during
my involvement with Youth With A Mission and University of the Nations. If I am accepted, I will abide by the spirit, rules, and schedule of the school.
Please sign your name below *

Emergency Information

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.
Your Signature *
I certify that all the information in this application and its supplements is complete and accurate.
Your Signature *
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