university of the nations - uofn battambang · web viewsklvitüal½yénrbcacati university of the...

sklviTüal½yénRbCaCatiUNIVERSITY OF THE NATIONS

v:ayv:am)at;dMbgBATTAMBANG (YWAM)

DTS EquipbMBak;nigcak;bMeBjbuKÁlik nig

GñkdwknaM DTSEquipping and Empowering DTS Staff and Leaders

kalbriec©TénBaküsMucUleron³ éf¶>>>>>>>>>>Ex>>>>>>>>>>>>qñaM Date of Application: D_____M______Y______

GtþsBaØaNIdentity:

eKatþnam>>>>>>>>>>>>>>>>>>>>>>>>>>>nam>>>>>>>>>>>>>>>>>>>>>>>>>>>>>eQµaHkNþal>>>>>>>>>>>>>>>>>>>>>>>>>>Last name: First name:__________________________ Middle:__________

eQµaHehaAeRkA>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>Nickname:___________________

ePT³ [ ]Rbus [ ]RsI Gayu³>>>>>>>>>éfExqñaMkMeNIt³éf¶>>

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>>>>>>Ex>>>>>>>>>>qñaM>>>>>>>>>>>>>>>>>>>>Sex: [ ]Male [ ]Female Age:____ Birth date: D____M_____Y_____

TIkEnøgkMeNIt>>>>>>>>>>>>>>>>>>>>>>>>>>>kMBs;>>>>>>>>>>>>>>>>>TMgn;Birthplace:______________________ Height:______ Weight:_____

karep¶IsMbuRt ¬rhUtdl;éf¶>>>>>>>>>>>>>>Ex>>>>>>>>>>>>>qñaM>>>>>>>>>>>>>>>>>>¦Mailing address: (Until: D_____M______Y______)

pøÚv¼elxsMbuRt³>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>Street/Box:_____________________________________________________________________________

extþ¼Rkug>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>rdæ>>>>>>>>>>>>>>>>>>>>>>>>>>>>elxkudRbeTs>>>>>>>>>>>>>>>>>>>>>City/Town:___________________________________ State:_________________ Zip:_____________

RbeTs>>>>>>>>>>>>>>>>>>>>>>>>2

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>Country:______________________

Gas½ydæanGciéRnþy_Permanent address:

pøÚv¼elxsMbuRt³>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>Street/Box:_____________________________________________________________________________

extþ¼Rkug>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>rdæ>>>>>>>>>>>>>>>>>>>>>>>>>>>>elxkudRbeTs>>>>>>>>>>>>>>>>>>>>>City/Town:___________________________________ State:________________ Zip:______________

RbeTs>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>Country:__________________________

elxTUrs½BÞ>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>Phone:___________________________

GIuEm:l>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

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>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>Email:__________________________________________________________________________

Bt’manGMBIlixitqøgEdn¼vIsaPassport/Visa information:

RbeTsénbuKál³>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>Country of citizenship:____________________________________________________________________

elxsnþisuxsgÁmenAGaemricU.S. Soc. Sec. #:___________________________

eQµaHenAelIlixitqøgEdn>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>Name as listed on passport:________________________________________________________________

Rkug nig RbeTsEdl)aneFVIlixitqøgEdn>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>City and country where passport was issued:_______________________________________

elxlixitqøgEdn³>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>éf¶putkMNt;³éf¶>>>>>>>>>>>>Ex>>>>>>>>>>>>>>qñaM>>>>>>>>>>>>vIsaPassport number:__________________________________ Passport expire date: D_____M_____Y_____ Visa

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RbePT ¬eRkABICnCatiGaemricb:eNÑaH¦³>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>kalbriec©T éf>>>>>>Ex>>>>>>>qñaM>>>>>>>>>>type (non US citizens only):______________ ___________ Date issued: D_____M_____Y_____

Rkug nig RbeTsEdleFVIvIsa>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>City and country where visa was issued:______________________________________________________

kalbriec©TputkMnt;énvIsa³éf¶>>>>>>>>>>>>>Ex>>>>>>>>>>>>>>>qñaM>>>>>>>>>>>>>>>>>>>>>>>>>Visa expire date: D_____M_____Y_____

etIelakFøab;eFVIlixitqøgEdn nig vIsamin)ansMercrWeT? [ ]Føab; [ ]minFøab; ebIFøab; sUmbBaöak;>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

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>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>Have you ever been denied a passport or visa? [ ]Yes [ ]No If yes, nation and details:_______________

______________________________________________________________________________________________________

______________________________________________________________ _____

Marital status:

lkçNHGaBah_BiBah_[ ]Single[ ] enAlIv[ ]

Pöab;Bakü¬kalbriec©Téf¶>>>>>>>>Ex>>>>>>>>qñaM>>>>>>>>>>¦[ ]

erobkarehIy¬kalbriec©Téf¶>>>>>>>>Ex>>>>>>>>qñaM>>>>>>>>>>¦[ ]Engaged (Date: D_____M______Y_____) [ ]Married (Date: D_____M______Y_____)

[ ]

EbkKña¬kalbriec©Téf¶>>>>>>>>Ex>>>>>>>>qñaM>>>>>>>>>>¦ [ ]

ElglH¬kalbriec©Téf¶>>>>>>>>Ex>>>>>>>>qñaM>>>>>>>>>>¦[ ]Separated (Date: D_____M______Y_____) [ ]Divorced (Date: D_____M______Y_____)

[ ]

erobkarmþgeTot¬kalbriec©Téf¶>>>>>>>>Ex>>>>>>>>qñaM>>>>>>>>>>¦[ ]eBaHm:ayrWemm:ay¬kalbriec©Téf¶>>>>>>>>Ex>>>>>>>>qñaM>>>>>>>>>>¦[ ]Remarried (Date: D_____M______Y_____)[ ]Widowed (Date: D_____M______Y_____)

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namRtkUl eQñaHeQµaHkNþal

Last name:________________________ First name:__________________________ Middle:__________

ePT Rbus RsI kalbriec©TénkMenIt éf¶ Ex qñaM TIkEnøgkMeNItSex: [ ]Male [ ]Female Birth date: D_____M______Y_____ Birthplace:____________________________

etIRbBn§rWbþIrbs;elakGñknwgmkCamYyrWeT?Will your spouse be accompanying you? [ ]Yes [ ]No

kUn ¬cMeBaHkumarEdlmkCamYyelakGñkb:ueNÑaH¦Children: (List only children coming with you).

namRtkUl eQµaHeQµaHkNþal


ePT Rbus RsI kalbriec©TénkMenIt éf¶ Ex qñaM TIkEnøgkMeNItSex: [ ]Male [ ]Female Birth date: D_____M______Y_____



ePT Rbus RsI kalbriec©TénkMenIt éf¶ 7

Ex qñaM TIkEnøgkMeNItSex: [ ]Male [ ]Female Birth date: D_____M______Y_____



ePT Rbus RsI kalbriec©TénkMenIt éf¶ Ex qñaM TIkEnøgkMeNItSex: [ ]Male [ ]Female Birth date: D_____M______Y_____

emedaH¬RtUvmkCamYykumareRkambIqñaM ehIyRtUvbMeBjBaküepSgeToteday\tKitéf¶¦Nanny: (Must accompany children under 3, separate student application required, no application fee.)



ePT Rbus RsI kalbriec©TénkMenIt éf¶ Ex qñaM TIkEnøgkMeNIt

Sex: [ ]Male [ ]Female Birth date: D_____M______Y_____

Birthplace:__________________________________________________________

kMnt;RtaBIbT]Rkidæ¬ebIelakGñkFøab;sUmBnül;[c,as;enAelIRkdasepSgeTot¦Criminal record: (If answer to either question is yes, please explain details on separate sheet of paper.)

etIelakGñkFøab;RbRBwtþbT]RkidærWeT? Føab; minFøab; ebIFøab;etIenAkEnøgNa nig

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eBlNaHave you ever been convicted of a felony? [ ]Yes [ ]No If so, when and where?____________________

_____________________________________________________________________________________

etIelakGñkFøab;RbRBwtþbT]RkidæxagpøÚvePTrWeT? Føab; minFøab; ebIFøab;etIenAkEnøgNa nig eBlNaHave you ever been convicted of a sexual crime? [ ]Yes [ ]No If so, when and where?_______________

______________________________________________________________________________________

Bt’manbnÞan;Emergency information:

enAkñúglkçx½NseRgÁaHbnÞan;Tak;TgRtUvCa

In case of emergency contact:______________________________ Relationship:_____________________

pøÚv ¼RbGb;sMbuRtStreet/Box:_____________________________________________________________________________

TIRkug¼extþ rdæelxkudRbeTs

City/Town:___________________________________ State:____________________ Zip:_____________

RbeTs elxTUrs½BÞCountry:______________________ Phone:_________________________

GIuEm:lEmail(s):_______________________________________________________________________________

enAkñúgl½kçx½NÐseRgÁaHbnÞan; eyIg´mann½yfaBYkeyIgyl;RsbkñúgkarBüa)al

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rUmbBa©ÚlTaMgkarcak;fñaMsnøb; nig eFVIkarvHkat;enAeBlEdldukT½r nig RKUeBTüKitcaM)ac;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.

htßelxarbs;dak;BaküsMucUleronApplicant’s signature:_____________________________________________________________________

kalbriec©Téf Ex qñaM Date: D______M______Y______

htßelxarbs;«Bukmþay rW GaNaBüa)al¬caM)ac;RtUvmanRbsinebIGñkdak;BakümanGayueRkam18qñaM¦Signature of parent or guardian: (Required if applicant is under 18 years of age.)

htßelxaSignature:______________________________________________________________________________

kalbriec©T éf¶ Ex qñaM RtUCaDate: D______M______Y______ Relationship:____________________

Bt’manTak;TgeTAnwgRkumCMnuMrbs;Gñkdak;BaküChurch information:

RBHviharEdlGñkfVaybgÁMRKUKgVal

Home Church:___________________________________ Pastor:________________________________

eKalCMenO10

Denomination:__________________________________________________________________________

elxpøÚv¼RbGb;sMbuRtStreet/Box:____________________________________________________________________________

Extþ¼Rkug rdæelxkudtMbn;

City/Town:___________________________________ State:_________________ Zip:________________

RbeTs elxTUrs½BÞCountry:______________________ Phone:_________________________

bTBiesaFn_kargar¬sUmbMeBjbTBiesaFn_kargarTaMgGs;taMgBIdb;qñaMmun cab;epþICamYybTBiesaFn_kargarfµI²enH¦Work experience: (Please list all work experience for the last 10 years, starting with most recent.)

muxtMEng Rkumh‘unPosition:____________________________ Company:__________________________________________

kalbriec©T³ Ex qñaM rhUt Ex qµaM eQµaHGñkRtYtRtaDates: M______Y_____ to M______Y_____ Supervisor:________________________________________

muxCMnajEdl)aneRbISkills used:____________________________________________________________________________


kalbriec©T³ Ex qñaM rhUt Ex qµaM eQµaHGñkRtYtRta

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Dates: M______Y_____ to M______Y_____ Supervisor:________________________________________



kalbriec©T³ Ex qñaM rhUt Ex qµaM eQµaHGñkRtYtRtaDates: M______Y_____ to M______Y_____ Supervisor:________________________________________









muxCMnajEdl)aneRbI12

Skills used:____________________________________________________________________________

CMnaj nig eTBekaslüepSg²Skills and talents:

CMnayénkargarcMnYnqñaMénbTBiesaFn_

Occupational skills:_________________________________________________ Years experience:______

xagtRnþI rW eTBekaslüepSgeTotcMnYnqñaMénbTBiesaFn_

Musical or other talents:_____________________________________________ Years experience:______

Pasa³ ¬sUmR)ab; nig dak;kMritPasaGg;eKøsrbs;elakGñkeGay)anc,as;las;¦Languages: (Please identify and rate your English language proficiency below.)

1>karsnÞnagay² 2>eRbIBakü)any:agl¥ 3>CMnajkñúgkareRbIPasaGg;eKøsmFüm [ ]1-Elementary speaking [ ]2-Limited word proficiency [ ]3-Minimum professional proficiency

4>CMnajx<s;kñúgkareRbI 5>niyaydUcCnCatiedIm 6>CaPasarbs;GñkEtmþg[ ]4-Full professional proficiency [ ]5-Native speaking proficiency [ ]6-Mother tongue

PasaepSgeTot nig kMritCMnaj³Other languages and proficiency:___________________________________________________________

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kMriténkarGb;rMEducational experience:

)anbBa©b;fñak; fñak;bfm Gnu¼viTüal½y enAkñúgGnu¼viTüal½yGrades completed: [ ]Grade school [ ]Secondary/High school [ ] Equivalent secondary/high school

saklviTüal½y )anTTYlsBaØab½Rt[ ]College/University [ ]Post graduate

viTüasßan kalbriecäT³ExqñaM dl; Ex qñaM

Institution:_____________________________________________ Dates: M_____Y____ to M_____Y____

kMrit¼muxviC¢akalbriecäT³Ex qñaM

Degree/Major _________________________________________________________ Date: M_____Y____

Gas½ydæan

Address:_______________________________________________________________________________





Gas½ydæanGas½ydæanAddress:___________________________________________________________________

____________

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Gas½ydæanAddress:___________________________________________________________________

____________






____________






____________

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____________

Rbvtþvayv:amYWAM History:

sUmEckcayGMBIsala v:ayv:amEdlelakGñk)ancUlrYmCamYyfµI²enHPlease share about any YWAM schools that you have previously attended.

eQµaHsala TItaMgkalbriecäT

School:_______________________ Location:_____________________ Date:______________________

eQµaHsala TItaMgkalbriecäT

School:_______________________ Location:_____________________ Date:______________________

Bt’manTak;TgnwgfvikaFinancial information:

etIGñkmanfvikaRKb;RKan;sMrab;salarWeT? )aT¼cas eT etIelakGñkmanfvikbu:nµan

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Do you have your complete school fees? [ ]Yes [ ]No What amount do you have? $_________________

RtUvkarb:unµaneTot?Amount still needed? $____________

mkBIRbPBNa etIenARtUvkarR)ak;mUlniFimkdl;rWeT?From what source will still-needed funds come?________________________________________________

etIelakGñkmanbMNulsMxan;EdlRtUvsgrWeT? man Gt;man ebImansUmBnül;Do you have any significant outstanding debts? [ ]Yes [ ]No If yes, explain: _______________________

______________________________________________________________________________________

karTTYlsÁal;eTAelITMnYlxusRtUvénfvikaAcknowledgment of financial responsibility:

ýl;BIkarbg;éføsalatMrUveGaybg;CaR)ak;duløataMgBIdMbUg rW k_bg;enAeBlEdl´mkdl;.elIsBIenH ýl;RsbkñúgkarCYbBiPakSakñúgeBly:agsmrmü taMgBIcab;epþImrhUtdl;bBa©b;sala GMBIR)ak;cMnayrbs;énAkñúgkMlugeBlEdlĆab;Tak;TgCamYy v:ayv:am ehIynwgsaklviTüal½yénRbCaCati. RbsinebI´RtUv)anTTYleGaycUleronenAkñúgsaklviTüal½yénRbCaCati ńwgRbRBwtþtam c,ab; nig kalvi)akrbs;sala.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 by the University of the Nations, I will abide by the spirit, rules and schedule of the school.

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htßelxarbs;Gñkdak;BaküApplicant’s signature:_____________________________________________________________________

kalbriecäT éf¶ Ex qñaM Date: D______M______Y______

htßelxarbs;«Bukmþay rW GaNaBüa)al¬caM)ac;RtUvmanRbsinebIGñkdak;BakümanGayueRkam18qñaM¦Signature of parent or guardian: (Required if applicant is under 18 years of age.)

htßelxaSignature:______________________________________________________________________________

kalbriecäT éf¶ Ex qñaM RtUvCaDate: D______M______Y______ Relationship:____________________

lixitbBa¢ak;Certification:

´sUmbBa¢ak;faral;Bt’manenAkñúgBaküsMucUleronenHKwBitR)akdehIyeTogRtg;I certify that all the information in this application is complete and accurate.

htßelxarbs;Gñkdak;BaküApplicant’s signature:_____________________________________________________________________

kalbriecäT éf¶ Ex qñaMDate: D______M______Y______

rbs;«Bukmþay rW GaNaBüa)al¬caM)ac;RtUvmanRbsinebIGñkda

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k;BakümanGayueRkam18qñaM¦Signature of parent or guardian: (Required if applicant is under 18 years of age.)

htßelxaSignature:_____________________________________________________________________________

_

kalbriecäT éf¶ Ex qñaM RtUvCaDate: D______M______Y______ Relationship:____________________

sUmep¶Iral;BakücUleronmkaPlease mail all forms to:

saklviTüal½yénRbCaCatiU of N

elxTUrs½BÞ³c/o Dr. Ouk Vitiea 931 Pothivong Phone: 855-12-731-650Battambang Email: [email protected] Website: www.uofnbattambang.com

saklviTüal½yénRbCaCatiUNIVERSITY OF THE NATIONS

)at;dMbgBATTAMBANG

DTS Equip sMnYrsMPasn_DTS Equip Application Questions

sUmGFisæaneGay)anc,s;las;enAeBlEdlelakGñkeqøIysMnYrTaMgGs;Please prayerfully answer these questions in the space provided

1>etIelakGñkeron DTS enAeBlNaehIyenAkEnøgNa

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1. When and where did you do your DTS?

2>etIelakGñkFøab;eFVIbuKÁl DTS EdrrWeT?b:unµandg?2. Have you staffed a before? How many?

3>etIGñkFøab;dwknaM¬GñkdwknaMsala¦ DTS EdrrWeT? b:unµandg?3. Have you lead (school leader) a DTS before? How many?

4>etIGVICaGMeNayTancMbgrbs;Gñk? 4. What do you consider are your major Spiritual Gifting(s)?

5>sUmBnül;BIB½n§kic©¼karRtas;ehArbs;elakGñk¬kareqHqYl-l-¦ 5. Please explain you Ministry/Vocational Calling (passions etc)

6>sUmBN’naBImUlehtuEdlelakGñkcg;cUlrYm

DTS Equip?etIelakGñkmaneKaledAc,as;las;sMrab;karhVwkhVWnenHrWeT?¬]Ta³GñknwgeFVICabuKÁlik/ dwknaMsala qab;²/ GñkbNþúHKMnit nig begáItsala DTS ¦6. Please describe your reasons for attending DTS Equip? Do you have any specific goals for your training (e.g. about to staff a DTS, soon leading a DTS, pioneering a DTS soon, etc.)?

7>etIGñkelakGñkmanGarmµN_dUcemþccMeBaHkardwknaMeTAkan;GnaKtrbs;RBHsMrab;Civ

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it?¬enAkñúgryHeBl5qñaMeTot¦ 7. How do you feel God is leading you in the future? (5 years out)

8>etIbTBiesaFn_GVIepSgeTotEdlelakGñkmanenAkñúg YWAM?¬sisS buKÁlik rWk_GVIepS¦8. What other experience do you have in YWAM? (student, staff or otherwise)

9>etIelakGñk)aneFVIGVIxøHenAkñúgkMlugeBl1qñaMmun? 9. What have you been doing over the last year?

10>etIelakGñk)anebþC¶acitÞkñúgkarbMerIkargarenAmUldæan YWAM rWkmµviFINamYyrWeT?ebIsin)an etIryHeBlb:unµan?10. Are you currently serving a commitment to a YWAM base or program? If yes, for how long?

11>etIelakGñkmantMrUvkarrbbGaharBiess rW tMrUvkarxagrUbkayEdrrWeT?¬]Ta³dUcCaCMgWTwkenamEp¥m/ Tas;cMNIGahar/ rWtMrUvkarekAGIsMrab;mnusSBikar¦ 11. Do you have any special dietary needs, or physical needs (i.e. diabetic, food allergies, wheelchair access, etc.)?

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)at;dMbgBATTAMBANG

lixitbBa¢ak;rbs;GñkeFVIkar¼RKU

beRgon¼GñkdwknaM v:ayv:am

EMPLOYER/TEACHER/YWAM LEADERREFERENCE FORM

sMrab;Gñkdak;Bakü³sUmbMeBjBaküenHehIy cuHhtßelxa nig biTEtmehIybBa©ÚneTAGñkdwknaM¼RKUbeRgon¼ GñkdwknaMYWAM edIm,IbMeBj.APPLICANT: Please fill in your information on this form, sign it and give it, with a stamped envelope, to your employer/teacher/ leader to complete.

Bt’manrbs;Gñkdak;BaküApplicant’s information:

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Last name:______________ ____________ First name:__________________________ Middle:________

dak;BaküsMrab;vKÁSchool applying for:______________________________________________________________________

´EdlmaneQµaHdUcxagelI KwKµansiTækñúgkarGanrWftcMlgcMeBaHlixitbBa¢ak; ehIIydwgfalixitminEmnCaGVIEdlRtUvEtmandUcCal½kçx½NÐedIm,IcUleronenaHI, the above named applicant, WAIVE any right I have to read or obtain copies of this recommendation, knowing that this waiver is NOT required as a condition for admission.

htßelxarbs;Gñkdak;BaküApplicant’s signature:__________________________________________________________________

kalbriecäT éf¶ Ex qñaM Date: D_______M_______Y_______

eQµaHGñkdak;BaküxagelI)andak;BakücUleronsaklviTüal½yénRbCaCati¬U of N ¦. U of

NKWCasaklviTüal½y epþateTAelIebskmµ ehIydMeNIrkareTA)aneRkamkarRtYtRtarbs; GgÁkaryuvCnbMeBjebskmµ (YWAM) EdlCa GgÁkar

GnþrCatiénRKIsÞbris½TbMeBjebskmµ ehIyTTYleGayRKb;nikaycUlrYm.v:ayv:amRtUv)ancab; epþImeLIgenAqñaM1960 ehIy\LÚvenHmanmUldæanrab;ryenAkñúg TIVbTaMgR)aMmYy.eKalbMNgmanrab;bBa©Úl

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TaMgkarhVwkhVWnnig CMrujeGayRKIsÞbris½T§bMeBjbMNgRBHhbJT½yrbs;RBHRKIsÞ{cUreTAbegáIteGaymansisSRKb;TaMgsasn_}KWCakarhVwkhVWnBIPaBCaGñkdwknaM eGayBYkeKecHeRbIR)as;CMnaj nig GMeNayTanehIybBaööÜnBYkeKeTAkan;RKb;kEnøgeTAkan;sklelak. The above applicant has applied for admission to the University of the Nations (U of N). U of N is a mission-oriented university under the auspices of Youth With A Mission (YWAM), an international, interdenominational Christian missionary organization. YWAM, founded in 1960, now has centers in hundreds of locations on six continents. Its purposes include training and challenging Christians to fulfill Christ’s command: “Go, therefore, and make disciples of all nations.” is a training and logistics base from which skilled workers are sent out into all the world.

karviPaKy:agm:t;ct;nwgpþl;Caeyabl;dl;Gñk dUecñHsUmbMeBjBaküenHy:agm:t;ct;.CakarRbesIrNas;ebIsinCaelakGñkbMeBjBaküsMucUleronenHkñúgryHeBly:agqab;rh½s¬kñúgryHeBl7éf¶¦KWBitCaRbesIrNas;.GrKuNsMrab;CMnYyrbs;elakGñk.sUmRtYtBinitüemIlcMnucxageRkamehIy pþl;eyabl;enAkEnøgEdlcaM)ac;.Serious consideration will be given to your comments; therefore we ask that you complete this form carefully. Your prompt attention in completing this form (within 7 days) is appreciated. Thank you for your assistance. Please check the following, and comment where necessary.

etIGñksÁÁal;buKÁlenHc,as;b:uNÑa? c,as;Nas; c,as; minsUvc,as;How well do you know the applicant? [ ]Very Well [ ]Well [ ]Casually

eyabl;epSg²Comments: ____________________________________________________________________________

______________________________________________________________________________________

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sUmGñkdak;kMriccMeBaHbuKÁlenHeTAtambuKÁllkçNénEpñkepSg² enAxageRkamenH?How would you rate the applicant in the following categories?

karsMerceKaledA kMritx<s; elImFüm mFüm eRkammFüm exSay

Initiative: [ ]Superior [ ]Above Average [ ]Average [ ]Below Average [ ]Inferior

KitBIGñkdéT

Concern for others: [ ]Superior [ ]Above Average [ ]Average [ ]Below Average [ ]Inferior

karsMrbxøÜneTAtamkEnøg

Social adaptability: [ ]Superior [ ]Above Average [ ]Average [ ]Below Average [ ]Inferior

smtßPaBkñúgkareFVItamAbility to follow: [ ]Superior [ ]Above Average [ ]Average [ ]Below Average [ ]Inferior

PaBCaGñkdwknaM Leadership: [ ]Superior [ ]Above Average [ ]Average [ ]Below Average [ ]Inferior

eyabl;¼karsMerc

Judgment/decision making: [ ]Superior [ ]Above Average [ ]Average [ ]Below Average [ ]Inferior

karnwgFwgEpñkGarmµN_ Emotional stability: [ ]Superior [ ]Above Average [ ]Average [ ]Below Average [ ]Inferior

suxPaB Health: [ ]Superior [ ]Above Average [ ]Average [ ]Below Average [ ]Inferior

rUbsm,tþi Personal appearance: [ ]Superior [ ]Above Average [ ]Average [ ]Below Average [ ]Inferior


______________________________________________________________________________________

smtßPaBénbBaØa qab;yl; mFüm

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Rkyl; Mental ability: [ ]Quick to comprehend [ ]Average [ ]Slow

xagkargar ]sSah_ xVHkarts‘U

Industry: [ ]Hard worker [ ]Average [ ]Lacks persistence

PaBTukcitþ)an bMeBjTMnYlxusRtUv xVHTMnYlxusRtUv

Reliability: [ ]Meets obligations [ ]Average [ ]Neglects obligations

PaBshkar shkar)anl¥ eKcBIskmµPaBRkum

Cooperativeness: [ ]Works well with others [ ]Average [ ]Avoids group activity

karbt;Ebn ebIkcMhehIypøas;ERb minbnÞn;tam

Flexibility: [ ]Open to change [ ]Average [ ]Unyielding

carwklkçN³RKIsÞbris½Tæ mantulüPaB minmaMmYn

Christian character: [ ]Well balanced [ ]Average [ ]Unstable

GarmµN_ eRtkGr GviCöman

Disposition: [ ]Cheerful [ ]Average [ ]Passive

kareKarBeBlevla eTogTat; Cajwkjab;ywt

Punctuality: [ ]Punctual [ ]Average [ ]Often late

TMnYlxusRtUvcMeBaHfvika 26

eGaytMélTMnYlxusRtUv eFVsRbEhs Financial responsibility: [ ]Honors obligations [ ]Average [ ]Neglectful


______________________________________________________________________________________

1>etIvisalPaBénskmµPaBkargarenAkñúgRBHviharrbs;buKÁlenHmanlkçN³dUcemþc?1. To what extent is the applicant active in church work?

______________________________________________________________________________________

2>etIbuKÁlenHmansIlFm’x<s;EdrrWeT? )aTman eT eyabl;epSg²2. Does he/she display high moral standards? [ ]Yes [ ]No Comments:

______________________________________________________________________________________

3>etIbuKÁlenHRbkan;BUCsasn_ sBa¢ati nig bkSBYkrWeT? )aT eT eyabl;epSg² 3. Is he/she prejudiced against groups, races or nationalities? [ ]Yes [ ]No Comments:

______________________________________________________________________________________

4>sUmbBa¢ak;BilkçN³énkarbMerIkñúgPaBCaRKIsÞbris½Tærbs;buKÁlenH ³ ykcitþTukdak; mFüm Fmµta 4. With reference to his/her Christian service, the applicant is: [ ]Dedicated [ ]Average [ ]Casual

Comments:_____________________________________________________________________________________________

______________________________________________________________________

5>kñúgkarviPaKrbs;elakGñk etIkMritmYyEdlBN’naBIbTBiesaFn_énRKIsÞbris

27

½Tærbs;buKÁlenH?5. In your consideration, which of the following would best describe the applicant’s Christian experience?

cas;TMu BitRtg; nwg lUtlas; BwgelIGarmµN_ esI²[ ]Mature [ ]Contagious [ ]Genuine and growing [ ] Over emotional [ ]Superficial

eyabl;epSg²Comments:_____________________________________________________________________________________________

______________________________________________________________________

6>srubmk/ etIelakGñkKitfaGVIEdlCacMnuucxøaMgrbs;buKÁlenH? ¬rab;bBa©ÚlTaMgsmtßPaBBiessEdr¦6. Overall, what do you consider to be the applicant’s strong points? (include special abilities)

______________________________________________________________________________________

______________________________________________________________________________________

7>sUmpþl;eyabl;xøH²GMBIRbvtþRKYsarrbs;buKÁlenH/ RbsinebIdwg7. Please comment on the applicant’s family background, if known:

______________________________________________________________________________________

______________________________________________________________________________________

8>enAkñúgKMnitrbs;elakGñk etIGVICMrujeGaybuKÁlenHdak;BakücUlsaklviTüal½yénRbCaCati?8. In your opinion, what are the applicant’s motives for applying to U of N?

______________________________________________________________________________________

______________________________________________________________________________________

9>etIsaklviTüal½yénRbCaCatiGaceFVIGVIedI28

m,IbEnßmeTAelIkarGPivDÄpÞal;xøÜnrbs;buKÁlenH?9. What could U of N do to aid in the applicant’s personal development?

______________________________________________________________________________________

______________________________________________________________________________________

10>sUmbEnßmcMnucepSg²EdlKYreGaykt;sMKal;¬]Ta³EpñkeBTü/ citþviTüa/ rWCab;Tak;TgnwgeRKOgejon nig eRKOgRsvwg/ rWsßanPaBCIvitepSg²EdlBYkeyIgKYrdwgBIbuKÁlmñak;enH¦10. Please add any relevant remarks (i.e. medical, psychological, drug or alcohol related, or other life situations we should know

more about): ______________________________________________________

______________________________________________________________________________________

11>etIelakGñkpþl;mtieGayeyIg´TTYbuKÁlenHeGaycUleronsaklviTüal½yénRbCaCatiEdrrWeT?11. Would you recommend the applicant for acceptance into the University of the Nations?

)aT eT )aTCamYykareRKagTukCamun[ ]Yes [ ]No [ ]Yes with reservations

eyabl;epSg²Comments:_____________________________________________________________________________________________

______________________________________________________________________

´)ansÁal; ryHeBl qñaM/

29

ehIyeCOfaKat;manKuNPaBdUc)anbgðajenAxagelI.I have known ______________________________________ for ____ years, and believe that he/she possesses the qualities

indicated above.

htßelxa Signed: ____________________________________________________________________________

kalbriecäT³éf¶ Ex qñaM Date: D_______M_______Y_______

eQµaH tYnaTIName: ______________________________________ Position: __________________________________

Gas½ydæanAddress: ______________________________________________________________________ ________

elxTUrs½BÞPhone: __________________________

etIelakGñkcg;TTYlBt’manbEnßmeTotGMBIEdrrWeT U of N/YWAM? )aT eTWould you like to receive further information about U of N/YWAM? [ ]Yes [ ]No

30

GñkvaytMélsUmep¶IBaküenHeTAkan;Evaluator, please mail this form to: U of N c/o Dr. Ouk Vitiea

pøÚvelx 931 BuT§ivgS931 Pothivong Phone: 855-12-731-650Battambang Email: [email protected] Website: www.uofnbattambang.com


)at;dMbgBATTAMBANG

lixitsþIGMBIsuxPaBsisSSTUDENT HEALTH FORM

GtþsBaØaNIdentity:

namRtkUl eQµaH eQµaHkNþalLast name:________________________ First name:__________________________ MIddle:__________

TUrs½BÞenApÞH GIuEm:lHome phone:____________________ Email:_________________________________________________

Bt’manEpñkviC¢saRsþMedical information:

eQµaHGñkEdlkan;kab;Fanar:ab;rg Tak;TgTUrs½BÞelxName of insurance carrier:________________________________ Contact phone:____________________

31

RbePTFanar:ab;rgelxénb½NÑFanara:b;rg

Policy type:___________________________________ Policy number:_____________________________

éf¶putkMNt; éf¶ Ex qñaMExpiration date: D______M______Y_______

Bt’manGMBIFanar:ab;rgBrief description of coverage:_______________________________________________________________

Kñúgl½kçxNÐbnÞan;sUmTak;Tg RtUvCaIn case of emergency contact:______________________________ Relationship:_____________________

elxpøÚv¼elxRbGb;sMbuRtStreet/Box:_____________________________________________________________________________

extþRkug rdæ elxkUdtMbn;City/Town:______________________________________ State:_________________ Zip:_____________

RbeTs elxTUrs½BCountry:____________________________________________ Phone:_____________________________

RbvtþsuxPaB³ ¬eqøIysMnYrTaMgGs;. sUmBnül;BIcMelIyEdlviC¢manxag enAelIRkdasmYyepSgeTot¦Health history: (Answer all questions. Explain positive answers below or on a separate piece of paper.)

etI\LÚvenHelakGñkman rW Føab;man cMnucEdlmancMnucEdlenAxageRkamenHEdrr

32

WeT?Do you now have, or have you ever had, any of the following?

Yes No Yes No Yes No

1>bBaðaEs,k 15>bBaðaebHdUg 25>CMgWxan;elOg [ ] [ ] 1-Skin condition [ ] [ ] 15-Heart trouble [ ] [ ] 25-Jaundice

2>bBaðaEPñk 16>sMBaFQamx<s; 26>eraKeføIm

[ ] [ ] 2-Eye trouble [ ] [ ] 16-High blood pressure [ ] [ ] 26-Hepatitis

3>bBaðaRtecok 17>sMBaFQamTab 27>bBaðaeBaHevon

[ ] [ ] 3-Ear trouble [ ] [ ] 17-Low blood pressure [ ] [ ] 27-Intestinal troubles

4>rbYsxYrk,al 18>eraKsnøak;q¥wgnigédeCIg 28>raKpÞÜn² [ ] [ ] 4-Head injury [ ] [ ] 18-Rheumatism/Arthritis [ ] [ ] 28-Recurrent diarrhea

5>QWk,alpÞÜn² 19>manbBaðaxñg 29>eraKTwkenamEp¥m

[ ] [ ] 5-Recurrent headache [ ] [ ] 19-Back problems [ ] [ ] 29-Diabetes

6>CMgWq¥ÜtRCUk 20>q¥wgxusknøak; 30>CMgWtMrgenam [ ] [ ] 6-Epilepsy [ ] [ ] 20-Dislocation of joints [ ] [ ] 30-Kidney disease

7>snøb;eRcIndg 21>)ak;q¥Wg33

31>eraKxVHQam [ ] [ ] 7-Fainting spells [ ] [ ] 21-Broken bones [ ] [ ] 31-Anemia

8> sµartIRcbUkRcbl; 22> eBaH¼

32>bBaðaTwkRbmat; nig RkBH [ ] [ ] 8-Mental/Nervous disorder [ ] [ ] 22-Stomach/Duodenal ulcer [ ] [ ] 32-Gall bladder problem

9>PaBeRkomRkMcitþ 23>CMgWqøgtampøÚvePT 33>mharIk¼duHsac; [ ] [ ] 9-Depression [ ] [ ] 23-Sexually transmitted disease [ ] [ ] 33-Cancer/Tumors

10>eraKxVin 24> karvHkat; 34>l½kçx½NÐEpñknarI [ ] [ ] 10-Paralysis [ ] [ ] 24-Surgery [ ] [ ] 34-Female conditions

11>eKgminlk; vHkat;ykExñgeBaHevon manrdUvmineTogTat; [ ] [ ] 11-Insomnia [ ] [ ] Appendectomy [ ] [ ] Irregular periods

12>dkdegðImxøI karvHkat;GamIdal;ecj rmYlRkeBIxøaMg [ ] [ ] 12-Shortness of breath [ ] [ ] Tonsillectomy [ ] [ ] Severe cramps

13>twgRcmuH¼hWt CMgWkønrdUvhUrmkeRcIneBk

[ ] [ ] 13-Hay fever/Asthma [ ] [ ] Hernia repair [ ] [ ] Excessive flow

14>Tas;cMNI epSg²34

\LÚvmanépÞeBaH [ ] [ ] 14-Allergies [ ] [ ] Other [ ] [ ] Now pregnant

bBa¢ak; bBa¢ak; epSg²Specify:_______________________ Specify:__________________________ ____ Other:____________________

CMgWepSgeTot nig l½kçx½NÐepSg²Other illnesses or conditions:_______________________________________________________________

karBnül;sMrab;cMnucxagelIExplanations for above:___________________________________________________________________

______________________________________________________________________________________

etIsBVéf¶enHelakGñkkMBugsßitenAeRkamkarEfrkSarbs;RKUeBTüEdrrWeT? )aT eTAre you presently under a doctor’s care? [ ]Yes [ ]No

bBa¢ak;Specify:_______________________________________________________________________________

etIsBVéf¶enHelakGñkkMBugelbfñaMCaRbcaM? )aT eTAre you presently taking any medication? [ ]Yes [ ]No

bBa¢ak;Specify:_______________________________________________________________________________

etIelakGñkTas; nig fñaMepSg²EdrrWeT? )aT eTAre you allergic to any drugs/medications? [ ]Yes [ ]No

bBa¢ak;Specify:_______________________________________________________________________________

35

etIelakGñkFøab;TTYlsMNgGMBIGsmtßPaBBIRbPBNaEdrrWeT?Are you now receiving or did you ever receive compensation for disability from any source? [ ]Yes [ ]No

bBa¢ak;Specify:_______________________________________________________________________________

______________________________________________________________________________________

etIelakGñkFøab;man PaBTn;exSayxagrUbkay/ Bikar rW l½kçx½NÐsuxPaBNaEdlRtUvkar karEfTaMBiessEdrrWeT?Do you have any physical impairments, handicaps or health conditions which require special attention?

)aT eT[ ]Yes [ ]No

bBa¢ak;Specify:____________________________________________________________________

______________________________________________________________________________________

srubmketIelakGñk KitfasuxPaBrbs;elakGñkmanlkçNdUcemþc? l¥Nas; l¥ KYrsm exSayHow would you rate your overall health condition? [ ]Excellent [ ]Good [ ]Fair [ ]Poor

CMgWEdlFøab;manDisease history:

etIelakGñkFøab;manCMgWqøgEdlmanenAeRk

36

amenHEdrrWeT?Have you ever had any of the following COMMUNICABLE DISEASES?

)aT eT )aT eTYes No Yes No

1>GutsVay 5>CMgWk¥kxøaMg[ ] [ ] 1-Chickenpox [ ] [ ] 5-Pertussis

2>kRBa¢il tUc 6>ekþAxøÜneLIgRkhm [ ] [ ] 2-Measles (rubella) [ ] [ ] 6-Scarlet fever

3>kRBai¢l FM 7>rebg² [ ] [ ] 3-Measles (rubeola) [ ] [ ] 7-Tuberculosis

4>BgelIEs,k 8>CMgWepSg [ ] [ ] 4-Mumps [ ] [ ] 8-Other

RbvtþsuxPaBkñúgRKYsarFamily history:

etIsmaCikNamñak;enAkñúgRKYsarrbs;GñkFøab;manCMgWdUcxageRkam?Have any of your immediate family members ever had any of the following?

Yes No Yes No

1>rebg 6>CMgWsnøak;édeCIg

[ ] [ ] 1-Tuberculosis [ ] [ ] 6-Arthritis

2>TwkenamEp¥m 7>CMgWQWeBaH [ ] [ ] 2-Diabetes [ ] [ ] 7-Stomach disease

37

3>CMgWRkelon 8>hWt¼tWgRcmuH [ ] [ ] 3-Kidney disease [ ] [ ] 8-Asthma/Hay fever

4>CMgWebHdUg 9>CMgWsán;¼CMgWRbkac; [ ] [ ] 4-Heart disease [ ] [ ] 9-Epilepsy/Convulsions

5>CMgWelIsQam 10>mharIk [ ] [ ] 5-Hypertension [ ] [ ] 10-Cancer

karcak;vHsaMugkarBarCMgWImmunizations:

RbePTCMgW eBlcak;fñaMbgáardMbUg¬enAGayu¦

fñaMcak;bgáareraKbEnßm¬enAGayu¦ DISEASE BASIC (year) BOOSTER (year)

elIkTI1 elIkTI2 elIkTI3 elIkTI1 elIkTI2 elIkTI3

1st dose 2nd dose 3rd dose 1st dose 2nd dose 3rd dose

CMgWxan;søak;Diphtheria: ________ ________ ________ ________ ________ ________

emtaNulTetanus: ________ ________ ________ ________ ________ ________

CMgWk¥kxøaMgPertussis: ________ ________ ________ ________ ________ ________

eraKxYrq¥wgxñg38

Polio: ________ ________ ________ ________ ________ ________

eraKkRBa¢ilRubella: ________ ________ ________ ________ ________ ________

BgEs,kMumps: ________ ________ ________ ________ ________ ________

eraKeføImRbePT A

Hepatitis A: ________ ________ ________ ________ ________ ________

eraKeføImRbePT B

Hepatitis B: ________ ________ ________ ________ ________ ________

Please mail all forms to: U of N c/o Dr. Ouk Vitiea 931 Pothivong Phone: 855-12-731-650Battambang Email: [email protected] Website: www.uofnbattambang.com

saklviTüal½yénRbCaCati

UNIVERSITY OF THE NATIONS

)at;dMbg39

BATTAMBANG

BaküsMucUleronsMrab;sisSSTUDENT APPLICATION

salabnÞab;bnSM Secondary School

e)aHbg;ecalsiTi§nig TMnYlxusRtUvWAIVER, RELEASE AND INDEMNITY

GñkEdlenAkñúgenHKWsMedAeTAelI{Gñke)aHbg;siTi§} mann½ymñak;enHKµansiTi§kñúgkardak;TMnYllxusRtUveTAelI saklviTüal½yénRbCaCati EdlCaGgÁkarkm<úCaeRkArdæaPi)al/ TTYlRKb;RKg/ nayk/ kmµiksmaCik/ Pñak;gar/ GñkeFVIkar/ ehIyebIsinGñksñg/ GñkFanar:ab;rg nig Gñksµ½RKcitþ EdlrYbrYmKñaenAkñúgenHKWeRbodUcCa{saklviTüal½y}BIkarepSg² nig RKb;TaMgTMnYlxusRtUv/ bþwgtv:a/ ehtukarmkBIskmµPaB/ )at;bg; ehIynwgkarxUcxac __________________________, who is herein referred to as the "Releaser", hereby releases, waives and forever discharges the UNIVERSITY OF THE NATIONS, INC., a Cambodian Non-Government Organization, its trustees, directors, officers, agents, employees, if any, successors, insurers and volunteers, who are herein collectively referred to as the "University" from any and all liability, claims, causes of action, loss and damage that may result from any injury to the Releaser’s person or property, even injury resulting in death of the Releaser, arising out of the Releaser being a Student, a Mission Builder, and/or a Full Time or Associate Staff member at or of the University, including without limitation of the generality of the foregoing those arising out of or in any way related to the Releaser participating in any University conducted or sponsored program or activity whether on the University Battambang, Cambodia campus, off campus within or outside of Cambodia such as an outreach program, which could be conducted outside of Cambodia.

Releaser hereby acknowledges that if Releaser participates in an outreach program conducted or sponsored by the University or travels internationally on University business that he or she is fully aware of the fact that his or her personal health, freedom, safety and/or life may be at risk of loss or damage from contraction of

40

disease, accidents, terrorism, persecution, war, political unrest and any other number of circumstances that might while traveling internationally or while participating in an outreach program and that the Releaser will give such risks the Releaser’s full consideration, prayer and thought in deciding whether or not to participate in any such activity and has given such risks the Releaser’s full consideration, prayer and thought in deciding whether or not to sign this instrument and that Releaser has signed this instrument with full knowledge of those risks, voluntarily, and not under any duress or undue influence of whatsoever kind or nature.

Releaser hereby knowingly and voluntarily assumes full responsibility for risk of loss of health, bodily injury, death or damage to Releaser’s property arising out of the aforedescribed risks, programs and activities. Releaser hereby agrees to indemnify and hold the University harmless from any and all claims, liability, loss, damage, cost and/or expense, including attorneys’ fees and costs incurred by the University in defending against any such claims and in enforcing this agreement, that may be asserted against the University or that the University may suffer or incur as the result of Releaser being a Student at the University or being a Mission Builder, and/or a Full Time or Associate Staff member at the University as the case may be.

Releaser expressly agrees that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as possible for any jurisdiction in which any cause of action or claim may arise or be asserted and is being given as an inducement to the University to allow Releaser to be a Student at the University or be a Mission Builder, and/or a Full Time or Associate Staff member at the University, as the case may be, and that if any portion of this agreement is invalid, it is agreed that the balance shall notwithstanding continue in full legal force and effect. This release, waiver and indemnity agreement shall be binding on Releaser and Releaser’s heirs, personal representatives, successors and assigns and shall inure to the benefit of the University and its trustees, directors, officers, agents, employees (if any), insurers and volunteers. RELEASOR ACKNOWLEDGES RELEASOR HAS CAREFULLY READ THIS AGREEMENT, FULLY UNDERSTANDS ITS LEGAL EFFECT AND HAS SIGNED IT OF RELEASOR'S OWN FREE WILL. In witness whereof, Releaser has executed this instrument on this day: ___________________, 20___.

Releaser’s Signature: ____________________________ Print Name:______________________________ Witness Signature: ______________________________ Print Name:_____________________________Please mail all forms to: U of N c/o Dr. Ouk Vitiea 931 Pothivong Phone: 855-12-731-650Battambang Email: [email protected] Website: www.uofnbattambang.com

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