Missionary Health Advisor Form

Application for Admission

Personal Data

FAMILY NAME:

MOTHER'S LAST NAME:

NAME(S):

AGE:

BIRTHDATE:

PLACE OF BIRTH:

SEX:

MaleFemale

PHONE OR CELL PHONE:

EMAIL:

APPLICATION DATE:

Personal and Family Data

CURRENT OR LAST OCCUPATION:

SKILLS OR JOBS YOU HAVE PERFORMED:

MARITAL STATUS:

SINGLEMARRIEDDIVORCEDSEPARATEWIDOWERMARRIED FOR THE 2ND TIME

HOW MANY CHILDREN DO YOU HAVE?

BOYS/GIRLS - Ages:

0-11-33-1011 or more

WHAT PLANS DO YOU HAVE WITH THEM WHILE ATTENDING CMS?

HOW MANY PEOPLE DEPEND ON YOU? HOW DO YOU PLAN TO MEET THESE OBLIGATIONS?

Address

STREET No / COLONY:

CITY:

STATE:

COUNTRY:

Emergency Contact

Reference 1

NAME:

ADDRESS:

PLACE:

PHONE:

RELATIONSHIP:

Reference 2

NAME:

ADDRESS:

PLACE:

PHONE:

RELATIONSHIP:

Christian Affiliation

7TH-DAY ADVENTIST?

YEAHNO

DATE OF BAPTISM:

CHURCH:

DISTRICT:

PASTOR'S NAME:

PASTOR'S DISTRICT:

PASTOR'S PHONE:

Studies and References

STUDIES CARRIED OUT:

PRIMARYSECONDARYPREPARATORYPROFESSIONAL

If you select PROFESSIONAL, specify:

Name some people who are or were at CMS that you know:

Personal Questions

13. When did you fully accept Christ as your personal Savior and surrender your life to Him?

14. Explain in your own words what Jesus means to you:

15. Briefly describe how you consider your past life:

16. What motivated you to apply as a CMS student?

17. What role does the Bible play in your life? What do the Scriptures mean to you and how do you use them?

18. What do you understand by conversion?

19. Did your conversion experience change your daily lifestyle? (Diet, music, clothing, makeup, social relationships, recreation, education)

YeahNo

Specify:

20. Which Spirit of Prophecy books have you read completely?

21. What evangelistic activities do you enjoy participating in?

22. In what church positions have you served?

23. What do you hope to gain from your time and experience at CMS?

24. What are your long-term goals?

Medical History

F. Medical history – Check the illnesses you have suffered from:

MeaslesGlaucomaRubiolaColdsMumpsLiver diseaseChickenpoxVaricose veinPolioThrombophlebitisScarlet feverDropDiphtheriaSinusitisMeningitisAsthmaTuberculosisEmphysemaMalariaArthritisBronchitisSpinal problemsPleurisyHigh blood pressureHepatitisHeart problemsBladder infectionAnemiaRheumatic feverTendency to bleedKidney diseaseNosebleedsKidney stoneSoreAttacksThyroid problemsHemorrhoidsAIDSGonorrhea-SyphilisBlood transfusionFatigue syndromeBirth defects

B. Usual recreational activities:

C. Do you watch television?

YeahNo

Hours per week:

Q. Do you exercise? What type and frequency?

E. Do you take any medicines or supplements?

YeahNo

Medication 1 – Dose – Duration:

Medication 2 – Dose – Duration:

Medication 3 – Dose – Duration:

Additional Questions

25. Do you agree with the preparation offered by the CMS in the seminar for Self-Supporting Health Missionaries?

YeahNo

26. When are you planning to come? (January, April, July, or October)

27. Do you understand that there is a cost for tuition, lodging and food?

YeahNo

28. For the installment financing plan, please contact us for more details.

Health Section

30. Have you ever been denied employment due to a physical illness?

YeahNo

Type of disease:

31. List any physical conditions that may limit your ability to work and study effectively:

Include a recent photo (jpg or png, max. 2 MB):

Pastoral Reference Letter

Ask your pastor to send you a letter with the following information and answers to the questions, and upload it below.

The aforementioned brother has applied for admission to the Missionary Health Center (CMS). We request an honest and sincere reference. The information will be kept confidential.

1. How long have you known the applicant and in what condition?

2. What do you consider to be the most marked abilities or values in your brother/sister?

3. Is there any area in your sibling's life where you need special advice or help?

4. Comments:

Assessment

A. Temperament: "Excellent" "Good" "Fair" "Unsatisfactory"

B. Spirituality: "Excellent" "Good" "Fair" "Unsatisfactory"

C. Service attitude: "Excellent" "Good" "Fair" "Unsatisfactory"

D. Diligence: "Excellent" "Good" "Fair" "Unsatisfactory"

E. Judgment: "Excellent" "Good" "Fair" "Unsatisfactory"

F. Relationship with the Adventist Church: "Excellent" "Good" "Fair" "Unsatisfactory"

G. Relationship with inspired advice: "Excellent" "Good" "Fair" "Unsatisfactory"

H. Acceptance of the Pro-Health Reform: "Excellent" "Good" "Fair" "Unsatisfactory"

I. Honesty: "Excellent" "Good" "Fair" "Unsatisfactory"

J. Intellect: "Excellent" "Good" "Fair" "Unsatisfactory"

K. Leadership skills: "Excellent" "Good" "Fair" "Unsatisfactory"

L. Stability: "Excellent" "Good" "Fair" "Unsatisfactory"

M. Ability to work with others: "Excellent" "Good" "Fair" "Unsatisfactory"

N. Attitude towards authority: "Excellent" "Good" "Fair" "Unsatisfactory"

5. To become part of CMS, the brother/sister is recommended: "without reservation" "with some reservations" "no, under the present circumstances" "no, under no circumstances"

Pastoral Data

Name:

Post:

District:

Date:

Address:

City:

State:

Country:

Tel:

Upload the letter: