Basic Information

Recent Photo *

Name *

Phone *

Email Address *

Street *

City

State

Zip

Country *

Citizenship *

Birth Date * +

Birthplace *

Legal Status *

US Citizen

Current Passport and Visa

Current Passport and Green Card

None of the above

Non USA Citizens only: Please enter valid US Visa type and number below.

Gender *

Male

Female

Marriage Status *

Single

Married

Other (explain) Other (explain)

If married, will your spouse be accompanying you? Will you have children (number) accompanying you? Please list names and ages of children.

Are you serving in YWAM, and what base? *

Have you done your DTS?

How did you hear about TESOL? *

What is your level of education? *

High School

Associates Degree

Undergraduate

Graduate

Language Questions

What is your English proficiency level? *

Do you speak any other languages? *

Yes

No

Which languages?

References

Pastor/Spiritual Mentor

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

YWAM Experience

Please indicate any schools you have done with YWAM or any staff positions you have held with YWAM

DTS

Crossroads DTS

Secondary School Secondary School

School Location

Have you staffed at a YWAM base before? Staffing location?

Medical

Are you currently under a doctor's care for any reason? *

Yes

No No

If yes, please explain.

Do you have any special dietary needs? (required if you are choosing room and board option) Please explain. *

Are you taking any medication at this time? *

Yes

No

If yes, please explain below.

Please list any medical conditions that you have or have had that might be beneficial for YWAM Greater Philadelphia to know about.

Youth With A Mission Greater Philadelphia requires all students to have medical insurance while participating in schools and programs. Do you have medical insurance? *

Yes

No, but I agree to purchase medical insurance to cover me during my stay at YWAM Greater Philadelphia. (required only if you are choosing room and board option)

No, but I am not choosing room and board option.

Emergency Contact

First Name *

Last Name *

Relationship *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Supplemental Questions

Describe your present devotional relationship with God. *

What expectations do you have about training and serving here at YWAM Greater Philadelphia? *

Why are you interested in TESOL? How do you see yourself using the skills you gain through this course? *

Do you plan to drive in each day ($800- Lunch included) or do you plan to stay on base ($1600- all meals included)? *

Drive In

Stay on Base

Pay application fee of $50 here.

PLEASE NOTE:

3 Different References Forms are Required:

• Pastor/Mentor
• Teacher/Employe
• Friend Reference