YWAM/University of the Nations

Hurlach.
Youth With A Mission Hurlach e.V.,
D-86857 Hurlach,Germany, E-mail: sdc@jmem-Hurlach.de
Tel: +49(0)8248/12238 Fax: +49(0)8248/12241

APPLICATION FORM

This application will be considered only after all of the items listed below have
been received.

Complete application, waving of Liability, including all signatures and all

requested information.

Non- refundable application fee of 70 euro

Photograph- two recent pictures of yourself ( passport photo)

2 reference forms completed by

a. Your pastor ( mentor, elder, youth leader)

b. Your Christian friend who knows you very well.

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 YWAM/University of the Nations
Hurlach.
Youth With A Mission Hurlach e.V.,
D-86857 Hurlach,Germany, E-mail: sdc@jmem-Hurlach.de
Tel: +49(0)8248/12238 Fax: +49(0)8248/12241

Please attach

2 recent passport
pictures

Application Forms for

School of Digital Communication

1. General Information (type or print clearly, please)

Surname/family name First name other

Permanent address (please no P.O. Box) current address (if different)

Home Phone Number Mobile phone Number

Home e-mail

Date of birth(dd/mm/yy) Place of birth

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 YWAM/University of the Nations
Hurlach.
Youth With A Mission Hurlach e.V.,
D-86857 Hurlach,Germany, E-mail: sdc@jmem-Hurlach.de
Tel: +49(0)8248/12238 Fax: +49(0)8248/12241

National citizenship

Passport number Date of expiry

Please attach scanned copy of passport if need be

2. Personal Information

Please give short answers to all the following questions on this application form and more
detailed answers, if necessary, on a separate sheet of paper. Identify each answer by question.
Please type or print clearly.

I. marital status

Single Engaged Married widower

Are you, or have you been separated or divorced?

Yes No

II. List the names of your children, if they are coming with you.

Name

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 YWAM/University of the Nations
Hurlach.
Youth With A Mission Hurlach e.V.,
D-86857 Hurlach,Germany, E-mail: sdc@jmem-Hurlach.de
Tel: +49(0)8248/12238 Fax: +49(0)8248/12241

III. Is there anything about the health of your children that we should know?

Yes No

If yes, please explain:

3. Health

A. Are you presently taking medication or are you under doctors treatment?

No Yes
If yes, please write down which drugs you are taking on prescription & why you are taking
them.

B. Have you ever been under psychiatric care?

No Yes

If yes, please explain why & where & how long:

C. Have you ever had an eating disorder?

No Yes If yes, please explain:

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 YWAM/University of the Nations
Hurlach.
Youth With A Mission Hurlach e.V.,
D-86857 Hurlach,Germany, E-mail: sdc@jmem-Hurlach.de
Tel: +49(0)8248/12238 Fax: +49(0)8248/12241

D. Do you have any specific diet or are you vegetarian?

No Yes

E. Have you ever been addicted to smoking, alcohol abuse, pornography or have taken
other drugs?

No Yes

If yes, please explain, how long have you been addicted and when you stopped

F. Have you ever engaged in occult practices?

No Yes If yes, please explain:

4. Work Experience, Hobbies and Academic Information

A. What education /occupation/work experience do you have? (including YWAM)

School/work

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 YWAM/University of the Nations
Hurlach.
Youth With A Mission Hurlach e.V.,
D-86857 Hurlach,Germany, E-mail: sdc@jmem-Hurlach.de
Tel: +49(0)8248/12238 Fax: +49(0)8248/12241

B. Describe your skills/ talents/ interests

C. What other U of N schools did you do? Are you studying for a degree with the U of N?
Please use extra sheet of Paper if needed.

D. What was the last school you attended in YWAM, please state name and contact
information of the Base.

E. What is your mother tongue?

What other language do you speak and how well (using the following scale)?

Language Fluent Good Basic

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 YWAM/University of the Nations
Hurlach.
Youth With A Mission Hurlach e.V.,
D-86857 Hurlach,Germany, E-mail: sdc@jmem-Hurlach.de
Tel: +49(0)8248/12238 Fax: +49(0)8248/12241

5. Emergency Information
Whom should we contact in any case of emergency?

Full name: Relationship to you:

Address Home e-mail

Mobile phone number

Home phone number

Work phone number

7. Costs

A. School fees
The total cost of the school is 2,200 Euro plus 70 Euro nonrefundable registration fee. This
includes your room, food, teaching material, tuition and travel costs during school outings.
It does not cover visa costs, personal costs and travel costs from your place of departure to
the location of the school and return. The total amount for the school is required on or
before your arrival. If there is any reason why this is not possible, please contact the school
leader.

B. Do you have your complete school fees

Yes No

If not, what source will they come from?

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 YWAM/University of the Nations
Hurlach.
Youth With A Mission Hurlach e.V.,
D-86857 Hurlach,Germany, E-mail: sdc@jmem-Hurlach.de
Tel: +49(0)8248/12238 Fax: +49(0)8248/12241

Do you have any debt at the moment?

Yes No

If yes please give details

RECOGNITION OF RESPONSIBILITY
No I cannot commit to take responsibility for my finances

Yes I will take responsibility for my finances, implications and cost of school.

Please explain how you plan to meet this obligation:

8. Self evaluation

A. How would you describe yourself?

Excellent Good Average Needs

improvement
Dicsipline/ self-control

Emotional stability

Self-esteem

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 YWAM/University of the Nations
Hurlach.
Youth With A Mission Hurlach e.V.,
D-86857 Hurlach,Germany, E-mail: sdc@jmem-Hurlach.de
Tel: +49(0)8248/12238 Fax: +49(0)8248/12241

Ability to take initiative

Relation to authorities

Openess to counseling

Reliability

Financial Responsibility

Concern for others

Willingness to work in
teams
Ability to handle
pressure
Ability to work
indepenently
Ability to study
independently
Communication skills

9. Studies

A. Do you have any learning difficulties e.g. dyslexia?

Yes No
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 YWAM/University of the Nations
Hurlach.
Youth With A Mission Hurlach e.V.,
D-86857 Hurlach,Germany, E-mail: sdc@jmem-Hurlach.de
Tel: +49(0)8248/12238 Fax: +49(0)8248/12241

If yes, please explain

B. Do you have problems with studying on your own?

Yes No

If yes, please explain

10. References

For your application you need 2 references that must be sent directly to the school. The
application will not be considered unless all is sent to us.

DTS leader / last school leader

Name:

Address:

Phone: email:

Mobile Phone:

Friend/spiritual leader/employer

Name:

Address:

Phone: email

Mobile phone:

11. Release of Liability

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 YWAM/University of the Nations
Hurlach.
Youth With A Mission Hurlach e.V.,
D-86857 Hurlach,Germany, E-mail: sdc@jmem-Hurlach.de
Tel: +49(0)8248/12238 Fax: +49(0)8248/12241

Project participants is arranged with rented YWAM owned vehicles or with scheduled flights
or other public transport.

12.
Name:

Date of birth:

Residing at:

Participating in the following school:

From: To: In:

I hereby release the University of the Nations and Youth with a Mission Hurlach,
Schlossgasse 1,86857, Germany including the staff, agents, volunteers and assistants from
any liability whatsoever arising out of injury, damage or loss which may be sustained by said
persons during the course of involvement with the University of the Nations. This is no longer
valid, if the course leader or the legal representatives of YWAM have proved to have operated
in deliberate or gross negligence.

Should YWAM through any insurance policies be entitled to any damage claims for Course
participants, then it is declared now, that such compensations will be passed directly to those
participants.
Place: Date: Signature:

13. Electronic storage of personal information

I hereby allow the electronic storage of personal information (performed in legal manner) that
has been attained and used for the organization of the course as well as for internal purposes.

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 YWAM/University of the Nations
Hurlach.
Youth With A Mission Hurlach e.V.,
D-86857 Hurlach,Germany, E-mail: sdc@jmem-Hurlach.de
Tel: +49(0)8248/12238 Fax: +49(0)8248/12241

I agree I dont agree

That this information be passed on to the Jugend mit einer Mission Deutschland Verband
e.V. / Youth with a Mission Germany and their encompassed works.

Place: Date: Signature:

14. Final signature

I certify that all information given in this application is complete and accurate.

Place: Date: Signature:

The application will be treated confidentially.

PS: Your application will not be considered until all the forms are sent in, all questions are
answered & the Registration Fee of 70 Euros paid.

Please mail, fax or scan and email the application to the following address:
Email:
Youth With A Mission,
Schlossgasse 1,
86857 Hurlach Germany.
Phone: +49 (0)8248122338
Fax: +49 (0)824812241

Please send your application fee through either of these:

Form Germany:
Bankname: Evangelische Bank Kassel e.G.
Empfnger: Jugend Mit Einer Mission Hurlach e.V.
IBAN: DE22 520 604 10 000 5330050

From Switzerland:
Empfnger: Jugend Mit Einer Mission Hurlach e.V.
Bank: Swiss Post, PostFinance, Nordring 8 , CH-3030 Bern
Konto-Nr.: 10-14588-7
Swift / BIC.: POFICHBEXXX
IBAN.: CH3609000000100145887
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 YWAM/University of the Nations
Hurlach.
Youth With A Mission Hurlach e.V.,
D-86857 Hurlach,Germany, E-mail: sdc@jmem-Hurlach.de
Tel: +49(0)8248/12238 Fax: +49(0)8248/12241

From Europe:
Recipient: Jugend Mit Einer Mission Hurlach e.V.
IBAN: DE 22520604100005330050
BIC (Swiftcode) GENODEF1EK1

From outside of Europe:

Name of the bank: Evangelische Bank Kassel
Recipient: Jugend Mit Einer Mission Hurlach e.V.
Swiftcode: GENODEF1EK1
Town: 34117 Kassel, GERMANY, Street: Seidlerstr. 6
IBAN: DE 22 520 604 10 000 5330050
Account Nr. 5330050
Via Internet
Bank: www.paypal.de
Konto: buchhaltung@jmem-hurlach.de

Purpose: SDC

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