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MTI Application Form
Personal Details
Name
(required)
Address
(required)
City
(required)
State
(required)
Zip Code
(required)
Country
(required)
e-mail
(valid email required)
Phone Number
(required)
Date of Birth
(required)
Gender
(required)
Marital Status
(required)
Do you have a current Passport
Yes
No
(required)
Nationality
(required)
Passport Number
(required)
Place of Issue
(required)
Date of Expiry
(required)
Are you blacklisted in any country?
Yes
No
(required)
If Yes, Why?
(required)
Confidential Section
Over the last 5 years have you been investigated, involved with, charged or convicted regarding: Drugs Child Abuse/Molestation, Sexual Immortality or Homosexuality.
Yes
No
If Yes Please give details
Qualifications & Employment
Education Level and Qualifications
(required)
Additional
(required)
Present Occupation
(required)
Trades/Practical Skills
(required)
Computer Skills
(required)
Languages Spoken
(required)
Other Skills/Abilities
(required)
Pastors Reference
Name
(required)
e-mail
(valid email required)
Phone Number
(required)
Relationship to Applicant
(required)
Employer's Reference
Name
(required)
e-mail
(valid email required)
Phone Number
(required)
Relationship to Applicant
(required)
Friend's/Family Reference
Name
(required)
e-mail
(valid email required)
Phone Number
(required)
Relationship to Applicant
(required)
Church Information
Church You Attend
(required)
Period of Attendence
(required)
Address
(required)
City
(required)
State
(required)
Zip Code
(required)
Country
(required)
Position Held in Church
(required)
Name of Pastor
(required)
Year of Salvation
(required)
Year of H/S Baptism
(required)
Do you Tithe to your Church
Yes
No
(required)
Briefly outline your ministry involvement with your current church
(required)
Previous Outreach Experience (Include dates, places and with whom)
(required)
Please include a paragraph on the following:
1.Your current relationship with God
2.Your expectations of the course
3.Your Future plans after the course
Medical History
List any Physical Disabilities or Ailments
************
Are you currently taking medication for any medical conditions
Yes
No
If yes, please state the condition and the medication
Other Medical Conditions
Allergies
Please state any allergies you have
What is your Blood Group
Please Note: failure to disclose relevant medications may result in your being sent
home
, however stating relevant conditions will not necessarily prevent you from being accepted into the course.
Other Relevant Information
State your financial ability to cover the cost of your course
(required)
Before you return your application please ensure you have:
1. Answered all questions clearly and accurately
2. Attached a recent passport size photo of yourself (in the space provided at the top of the document)
3. Included a separate page with the the requested paragraphs
4. Requested references from your Pastor, employer and friend to be filled out and returned by email or post
The COC Thailand Missionary Training Institute Declaration
I, the person named in, and signatory to the application, do declare that the above information is true and accurate
If selected to be a student of the Missionary Training Institute(MTI), I agree:
1. To obey all instructions of the appointed supervisor
2. To participate in ALL activities, travel and programs of the course inclusive of outreach activities, foods, accommodation as required by the appointed supervisor
3. To receive, or be current with the following vaccinations: Routine childhood immunizations and Hep A, Thyphoid
4 The following vaccination are 'recommended': Hep B. Rabies is available in in Thailand if needed. COC Thailand will provide malaria prophylaxis for the one week that you will need it, if this is unsuitable alternative medicine is available here.
5. To show proof of Travel Insurance Documents and an open return ticket. (photocopy)
6. To sign the
HAVEN
Project Liability Disclaimer deed
7. Not to enter into private arrangements to visit on subsequent trips with persons, churches, or contacts previously established by COCThailand without the consent of the HAVEN Project or COC Thailand National Office.
Name
(required)
Signature
(required)
Date of Signature
(required)
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