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Undergraduate Admissions

Outtatown Application Form

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 Outtatown Burkina Faso (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.

Required fields are marked with an asterisk (*)

Step 1: Personal Information
Name
Title  Mr.    Miss    Mrs.    Ms.    Mx.
First Name *
Middle Name
Surname *
Previous Surname
(If Applicable)
Preferred Name
Contact Information
Mailing Address *
City/Town *
Prov/State *
Postal/Zip Code *
Country *
Phone Number * - -
Cell Number - -
Email Address *
Parents and Guardians
Names of Parents / Guardians
Mailing Address
City/Town
Province/State
Postal/Zip Code
Phone Number - -
Email Address
Emergency Contact (If Different From Above)
Emergency Name
Emergency Phone - -
Relationship to Applicant Parent
Guardian
Spouse
Other:  
I authorize my parent/guardian/emergency contact to discuss my application and provide information to CMU on my behalf:
  Yes
No
Other Information
Date of Birth * (yyyy-mm-dd)
First Language (Refers to Mother Tongue) * English
French
Other:  
If English is not your first language, indicate the number of years of English instruction you have received:
 
Marital Status
High School Graduation Year *
Gender *
Country of Citizenship *
If not a Canadian Citizen, choose one of the following: Permanent Resident
Applying for Student Visa
Student Visa
Refugee
Country of Birth
List other universities/colleges to which you are applying:
If you are of Aboriginal ancestry, please specify: First Nations (Status)
First Nations (Non-Status)
Inuit
Metis
Other
What are you doing now? * Student
Working
Other:  
Religious Affiliation
Denomination
Home Church
No Affiliation (check if not affiliated with any church or denomination)
Step 2: Medical Information
Provincial Health Insurance
(For Canadians: name province where insured followed by policy number)
Private Insurance
(For Americans, and also for Canadians with additional coverage: name of provider, policy number, and phone number)
In order to serve you better, please disclose information that may require accommodation for physical, learning, and mental health reasons. This may include any physical limitations, learning disabilities, allergies, or mental health issues you have. This declaration is voluntary. Please note, CMU strives to provide a fair and supportive learning environment for academically qualified students with disabilities. Disabilities include both mental and physical conditions, which meet the following criteria: The condition is permanent, ongoing, episodic, or of some persistence, and the condition causes a significant limit for the person in carrying out some of life's major activities.
Step 3: Educational Information
Please list in chronological order the high schools (since grade 11), colleges and universities attended (name, location, dates attended, graduation date) *
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.
My first choice for where I would like to spend the international term is: *
  Two Semesters: Canada/Guatemala
Two Semesters: Canada/South Africa
One Semester: Canada/Burkina Faso
I wish to join Outtatown in * September 2018
How would you rate yourself in the following categories?
  Above Average Average Below Average
Personal Initiative *
Concern for Others *
Social Adaptability *
Ability to Follow *
Leadership *
Judgment/Decision Making *
General Health *
Physical Ability (Hike, Canoe, Carry Backpack) *
Interest in Christian Community *
Industry * Hard Worker
Average
Lack Persistence
Reliability * Meet Obligations
Average
Neglect Obligations
Cooperativeness * Work Well with Others
Average
Avoid Group Activity
Flexibility * Open to Change
Average
Unyielding
Disposition * Cheerful
Average
Passive
Punctuality * Punctual
Average
Often Late
Financial Responsibility * Honour Obligations
Average
Neglectful
Participation in Your Church * Very Involved
Average
Rarely Attend
Participation in Sports / Community / School Events * Extremely Involved
Average
Avoid Participating
Love of Adventure * Will Try Anything Once
Average
Too Risky
Comments
Please answer all of the following questions
List your extracurricular activities. (i.e. sports, music, drama, hobbies, etc.) *
Describe any volunteer experience/community service. *
Please list and briefly describe any previous travel experience. *
Describe your involvement with your local church. *
Please describe an experience that removed you from your comfort zone. How did you overcome the challenge? *
Describe how you handle conflict/difficult situations. *
Why do you want to participate in the Outtatown program? What do you hope to accomplish in this year? *
What will be your biggest challenge if you go on an Outtatown school? *
What are the three best things that you bring to the school? *
As a discipleship program, our focus is on inspiring students to follow Jesus. Tell us why this focus is of interest to you. *
Describe your relationship with God (both past and current) and what you are doing to grow in your faith. *
What's the long term plan for your life: Any special plans or aspirations you're considering or dreaming about? *
Right after the Outtatown experience, I plan to: * Work for a While
Go to College
Go to University
Other
Are there other things about you that you would like us to know (family, work, gifts, etc.)? *
How did you hear about us?
How did you hear about CMU & Outtatown? * Radio/Print Advertising
Social Media
Website
Outtatown Student/Alum
CMU Student/Alum
CMU Faculty/Staff
Sibling
Parent
Other Relative
Church Visit
Pastor/Youth Leader
School Visit
Guidance Counsellor/Teacher
School Coach
Peace It Together Conference
Other:  
What is Your #1 Influence for Choosing CMU? CMU Admissions Counsellor
Athletics
Church Leader
Class Sizes
CMU's Faculty
Faith-Based University
Family
Friend
Guidance Counsellor/Teacher
CMU's Programs
Other:  
References
Reference #1
Ref #1 Phone - -
Ref #1 Email
Reference #2
Ref #2 Phone - -
Ref #2 Email
Reference Forms I have given reference forms to the 2 people named above
Additional Information
(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.)
Have you ever been suspended or expelled from a secondary or post secondary school? *
  Yes
No
Have you ever been convicted of a misdemeanour or felony? *
  Yes
No
If the answer is yes to either question, please explain the circumstances and date of incident(s).
Step 4: Commitment & Confirmation
Your Outtatown Commitment
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.
Note: Your personal information provided on this form will be used by CMU for purposes of admission, registration, and communication with you. Your information will be provided, as required, to Statistics Canada, to the Council on Postsecondary Education in Manitoba, and to other authorized government departments. Your name, address, year-level, church affiliation, declared program, and the name of your high school will be shared with CMU's offices working with External connections including student recruitment, development, and alumni. Alumni records will be maintained indefinitely for purposes of maintaining contact with former students.
By applying to CMU or any of its programs, I give consent to the submission of personal data to Manitoba Finance for purposes of administration and enforcement of the Manitoba Tuition Fee Income Tax Credit Program.
Confirmation
Confirmation * I confirm that the above statements and supplied information are true
Name *
Date * (yyyy-mm-dd)
References
In order to complete processing of this application, please obtain two references. www.cmu.ca/docs/forms/Outtatown_Personal_Reference.pdf
Step 5: Application Fee
Application Type * Until November 30: No Fee
After November 30: $80 Fee (non-refundable)
Other Payment Arrangements Authorized by CMU Admissions
        (Contact us at info:@:cmu.ca or 204.487.3300 if you require a code.)

Note: Your application will not be complete until your application fee, official transcripts, and reference letters have been received.