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| Step 1: Personal Information |
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We’re glad that you are interested in CMU’s Outtatown Discipleship
School! We are currently offering three international programs:
Outtatown Guatemala (2 semesters); Outtatown South Africa (2
semesters); and new for Fall 2010 – Outtatown French Africa (1
semester). The first half of Outtatown will be spent throughout various
locations in Canada. To help us serve you better, please tell us more
about yourself and your preferred location.
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Name
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First Name
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Middle Name
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Surname
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Preferred Name
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Mailing Address, Phone and Email
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Street
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City / Town
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Province / State
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Postal / Zip Code
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Country
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Phone
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Cell
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Email
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Parents / Guardians
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Names of Parents / Guardians
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Street
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City / Town
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Province / State
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Postal / Zip Code
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Phone
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Email
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Emergency Contact (if different from above)
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Emergency Name
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Emergency Phone
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Relationship to Applicant
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Parents
Guardian
Spouse
Other
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Other Information
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Date of Birth
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First Language
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English
French
Other
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Marital Status
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Single
Married
Separated / Divorced
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High School Graduation Year
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Gender
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Male
Female
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Citizenship
Are you Canadian?
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Yes
No
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If no, are you
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Permanent Resident
Have a study permit
Refugee
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Place of Birth
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Other universities / colleges you are applying to
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What are you doing now?
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Student
Working
Other
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Religious Affiliation
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Denomination
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Name of Home Church
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Not affiliated with any church or denomination
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| Step 2: Medical Information |
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In order to serve you better, please disclose information that may require accomodation for physical, learning, and mental health reasons.
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Provincial Insurance (For Americans, and also for Canadians with additional coverage; name of provider, policy #, and phone number)
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State of health in the past year
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Excellent
Good
Fair
Poor
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If your health was fair or poor, please explain
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List allergies, if any
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List medications you take regularily
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Do you have any dietary or special considerations we should know about?
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| Step 3: Educational Information |
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Please list in chronological order the high schools (since grade 11), colleges, and universities attended (name, location, dates attended, graduation date)
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Note: If you are in high school, college, or university you need to mail an official interim transcript to CMU. If you have completed high school, college, or university, you must also provide an official transcript. Photocopies and faxes are not acceptable. See the Apply Online page for instructions about sending official transcripts to CMU.
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My first choice for where I would like to spend the international term is:
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Guatemala (2 semesters)
South Africa (2 semesters)
French Africa (1 semester)
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How would you rate yourself in the following categories?
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Industry
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Hard worker
Average
Lack persistence
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Reliability
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Meet obligations
Average
Neglect obligations
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Cooperativeness
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Work well with others
Average
Avoid group activity
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Flexibility
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Open to change
Average
Unyielding
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Disposition
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Cheerful
Average
Passive
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Punctuality
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Punctual
Average
Often late
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Financial responsibiltiy
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Honour obligations
Average
Neglectful
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Participation in your church
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Very involved
Average
Rarely attend
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Participation in sports/community/school events
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Extremely involved
Average
Avoids participating
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Love of adventure
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Will try anything once
Average
Too risky
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Please answer all of the following questions
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List your extracurricular activities (i.e. sports, music, drama, hobbies, etc.)
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Describe any volunteer experience/community service
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Please list and briefly describe any previous travel experience
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Describe your involvement with your local church
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Please describe an experience that removed you from your comfort zone. How did you overcome the challenge?
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Describe how you handle conflict/difficult situations
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Why do you want to participate in the Outtatown program? What do you hope to accomplish in this year?
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What will be your biggest challenge if you go on an Outtatown school?
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What are the three best things that you bring to the school?
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Describe your journey with Jesus.
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Describe your current spiritual relationship with God and what you are doing to grow in your faith.
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What's the long term plan for your life: Any special plans or aspirations you're considering or dreaming about?
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Right after the Outtatown experience, I plan to:
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Work for a while
Go to College
Go to University
Other
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Are there other things about you that you would like us to know (family, work, gifts, etc.)?
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How Did You Hear About Us?
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How did you hear about CMU
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Radio
CMU Student
Church visit
Sibling
Pastor / Youth Leader
Missionfest
Website
CMU faculty / staff
PIT
School visit
Guidance counselor
School coach
Other
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What was your #1 influence for choosing CMU?
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Parent
Friend
Pastor
Coach
Guidance Counsellor
Other
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Additional Information
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(This information is required due to the nature of a traveling community, international legal issues and the work we do with children and youth ministries.)
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Have you ever been suspended or expelled from a secondary or post secondary school?
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Yes No
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Have you ever been convicted of a misdemeanour or felony?
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Yes No
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If the answer is yes to either question, please explain the circumstances and date of incident(s).
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Your Outtatown Commitment
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It is important that you are . . .
- a seeker committed to growth in your understanding of Jesus Christ and the Christian life.
- willing to respect and work with Outtatown staff.
- willing to be involved in activities of churches and communities where you go with Outtatown.
- willing to be flexible, adjusting to new ideas and cultures.
- willing to live within a group, and work at problems and relationships with honesty.
- willing to live simply and healthily, respectful of other cultures.
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Consent
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I consent to have the following individual(s) (e.g. parents) discuss my application and financial account with appropriate CMU staff.
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Name(s)
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Relationship
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Street
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City/Town
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Province/State
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Postal/Zip Code
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Phone
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Cell
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E-mail
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Confirmation
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I confirm that the above statements and supplied information are true
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Name
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Date
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| Step 4: $50 Application Fee (free if you apply before Nov 30) |
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Payment Method
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Click here to proceed to online payment of your Application Fee by credit card ($50).
Click here if you will pay later by cheque.
Click here if applying before Nov 30
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Send to:
CMU Outtatown Admissions
500 Shaftesbury Blvd.
Winnipeg, MB
R3P 2N2
Note: (if applicable) Your application will not be complete until your application fee, official transcripts and reference letters, have been received.
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