Preferred First Name

Surname

Address Line 1

Address Line 2

Town/City

County

Country

Postcode

Home Telephone

Mobile

E-mail Address

Date of Birth

day

month

year

Gender

Please indicate if you have any special needs or are under medical treatment.  

Please indicate if you have been convicted of any offence in relation to children or been refused permission to work with children.

How long have you been a Christian? If less than 5 years please indicate the number of years and months.

Briefly describe how you became a Christian and your subsequent Christian experience.

Briefly comment on your relationship with God at this present time.

Please provide details of your work experience to date.

Please provide details of your Christian service experience to date.

Please provide details of your educational experience to date.

Please explain why you want to apply for the YCC Gap Year.

Church Leader’s First Name

Surname

Address Line 1

Address Line 2

Town/City

County

Country

Postcode

Contact Telephone

E-mail Address

To the best of your knowledge is the information contained in this form true?

Yes

No

SPIRITUAL HISTORY

PREVIOUS EXPERIENCE

CHURCH LEADER’S DETAILS

APPLICANT’S DECLARATION

PERSONAL DETAILS