TESOL Application Form

Passport Details
Country of Citizenship*
Passport Number*
Place of Issue*
Date of Issue*
Expiry Date*
Contact Information
Address*
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Telephone*
Fax
Email*

Emergency Contact
Who do we contact in case of an emergency involving you?
Name*
Relationship*
Address*
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Family
List the names, dates of birth and passport numbers of children accompanying you (please include additional children in a separate sheet of paper)
Child 1
Name
Date of Birth
Sex
- Male
- Female
Passport Number
Expiry Date
Child 2
Name
Date of Birth
Sex
- Male
- Female
Passport Number
Expiry Date
Child 3
Name
Date of Birth
Sex
- Male
- Female
Passport Number
Expiry Date
Child 4
Name
Date of Birth
Sex
- Male
- Female
Passport Number
Expiry Date

Additional Questions
Describe your reason for doing the TESOL course*
Please list your academic levels achieved*
Current and previous employment*
Do you have any previous experience in YWAM?*
Do you have any previous teaching English?*

Finances
Do you have your complete school fees?*
- Yes
- No
How much do you presently have? CND*
How do you anticipate the provision of the outstanding balance of your school fees?*
Do you have financial support?*
- Yes
- No
Releases
1. Release of Liability

I do hereby release Youth With A Mission, Inc., its agents, employees, and volunteer assistants from any liability whatsoever arising out of any injury, damage or loss which may be sustained by myself or other persons during my/their course of involvements with Youth With A Mission.

2. Statement of Burial

I agree that is any case of my death while in Youth With A Mission – Canada. Youth With A Mission Canada may carry out the burial in the location of the deceased. If my family desires to have the body shipped home, my family will pay for it. I hereby absolve Youth With A Mission Canada and its entire staff and associates of the burial costs.

3. Legal Proceedings

I will make aware any current or pending law suits or legal proceeding.

4. Police Record

I will make aware any police record (civil or military).

5. Consent For Treatment

In an event of an emergency in which I am rendered unconscious and my nearest responsible relative or guardian cannot be contacted, I hereby agree to such treatment, anesthetic and operation to be performed upon myself as in the opinion of the attending physician/s is deemed necessary.

6. Acknowledgement of Financial Responsibility

I confirm that I understand payment of the required school tuition and fees must be made on or before my arrival, unless otherwise arranged with leadership, and I agree to do so. I also confirm that I am fully aware of my financial obligations, both to the Lord and to the students and staff at the school. I therefore accept all responsibility for my fees, tuition and personal expenses incurred during my involvement with Youth With A Mission.

7. Permission

I give permission to Youth With A Mission – Canada, to use any photographic, imaging or written material in regards to myself in promotional and marketing media. If applicant is under 18 years of age, signature of parent/guardian is also required-see bottom of the page.

8. Declaration

I declare that all the information contained herein is true, correct and complete to the best of my knowledge. I confirm that I have read the “Student information Handbook, attached to this application form, and that I agree with it.

9. Parent/Guardian Declaration

I have read all the above statements and agree with them as the legal parent/guardian of the applicant.
Are you involved in any current or pending law suits or legal proceeding?*
- Yes
- No
Legal Proceeding Details
Do you have a police record (civil or military)?*
- Yes
- No
Police Record Detail
Type Your Name to Agree*
Guardian Type Name to Agree (if necessary)

Feedback
1. Are there any matters you would to make mention of relating to any of the questions and/or forms previously?*
2. Are there any matters you would like to make mention of not covered in the questions above?*
3.How did you find out about the course you are applying for:*
- Recommended by Base / Campus Staff
- YWAM ESL Okanagan Website
- Other YWAM Base / Campus
- GO Manual
- YWAM e-group news
- Other

ESL Okanagan

ESL Canada

TESOL Student Application, University of the Nation, Canada

Step 1 of 6 -

Full Legal Name

Personal Details

Passport Details

Contact Information

Emergency Contact

Family

Child 1

Child 2

Child 3

Child 4

Additional Questions

Finances

Releases

Feedback

Translator

ESL

TESOL

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Contact

ESL Canada