Asia Gateway - Missional Leadership Residential Programme

Asia Gateway - Missional Leadership Residential Programme

Application Form

I. PERSONAL DETAILS

Title: Mr/ Miss/ Mrs/ Ms/ Pr / Rev/ Dr / Others ______

Name (as on IC or passport): ______Date of Birth: ______

Nationality: ______Visa Required: Yes / No Gender: Male / Female

Ethnic Group: ______Main language spoken: ______

IC/ Passport No.: ______Status: Married/Single/Widowed/Divorced/Separated

Spouse Name: ______

Children’s Names & Ages:

1. ______

2. ______

3. ______

Home Address:______

______

Postcode: ______Country: ______

Residential Address (if different from home address above): ______

______

Postcode: ______Country: ______

Special Medical Allergies (if any):______

Dietary requirements (if any):______

Any Disabilities:______

Any Previous Criminal Convictions: ______

Church Name & Address:______

Church Pastor/Leader:______

II. EDUCATION (Theological, Professional & Others)

Qualification gainedName of Institution Dates

1. ______

2. ______

3. ______

4. ______

III. EMPLOYMENT

Position Company/Organisation Dates

1. ______

2. ______

3. ______

4. ______

IV. CHURCH or OTHER CHRISTIAN MINISTRIES

Position Dates

1. ______

2. ______

3. ______

4. ______

V. LANGUAGES

Language Spoken Written

1. ______

2. ______

3. ______

4. ______

VI. CROSS-CULTURAL/MISSION EXPERIENCE (Where, When & With Whom?)

1. ______

2. ______

3. ______

4. ______

VII. FINANCING (Tick Appropriate)

How would you finance your course? Own Church Agency Others *

* Others, pleasespecify ______

VIII. MEDICAL FITNESS

A Doctor’s certification that you are medically fit to attend the training in full.

IX. REFERENCES (Compulsory for those applying for residential training)

3 Reference letters: 1. mission agency leaderor pastor, 2. another church leader, and 3. a friend.

X. APPLICATION COMPLETION CHECKLIST

A copy of a recent, passport-sized photograph

A copy of your IC and/or passport identity pages

Testimony

A doctor’s certification (refer VIII. above)

3 Reference Letters (refer IX. above)

A non-refundable application fee of RM50

XI. SUBMISSION

All Application papers and documents could be submitted electronically by emailto <

XII. PAYMENT

Application fee can be made via direct online funds transfer to our Bank Account, or bank-in cash/ cheque via ATM to our Bank Account if you are in Malaysia.

Append below are our banking details:

Account Name:AsiaCMS Berhad

Account No.: 359-418407-101

BankName: HSBC Bank Malaysia Berhad

Branch: Damansara Heights, Kuala Lumpur, Malaysia

SWIFT Code: HBMBMYKL

Reference: Application Fee [Your name]

Note:

Payment by online banking or direct bank-in via ATM, please submit the Online funds transfer Receiptor the ATM’s deposit Receipt with your application.

XIII. DECLARATION

I, ______hereby make a formal application to study at Asia

Gateway Training and confirm that the information given above is true and accurate. It is my

understanding that I am fully responsible for my support, travel, study materials, children’s education

and emergency medical expenses that may arise during the course of my training at Asia Gateway

Training.

Upon acceptance into this residential training, I shall abide by the rules and regulations of Asia Gateway Training. Thestaff and faculty shall not be held responsible for any indebtedness incurred by me during this saidtraining. I will endeavour to uphold a good and Christian testimony for the duration of the training.

______

(Applicant’s Signature) Date

Version 2016-08 1 | Page