U of N Historical Course Documentation Form: Purpose Statement and Procedural Explanation

U OF N HISTORICAL COURSE DOCUMENTATION FORM
PLEASE MAKE AND RETAIN A COPY OF THIS FORM FOR YOUR OWN RECORDS!
(To be used only by U of N Degree Students)
PURPOSE STATEMENT and PROCEDURAL EXPLANATION:

This form may be used for documenting an individual student’s participation in non-registered YWAM courses.
All documentation must be:
a. Provided by the student;
b. Verified by the school leader/staff;
c. Approved by the appropriate International College/Faculty Dean or Centre Director; and
d. Accompanied by a US$ 25 registration fee.
STUDENT INFORMATION:
U of N Student ID number (if known): ________________ U of N Degree being pursued: __________________________________
Student's Legal Name_:_________________________________________________________________________________________

Last/Family First/Given Middle Any other name used (Family Name before marriage etc.)
Birth date (please spell month): __________________ Student's Citizenship: _____________________ S_ex: Male ____ Female ____
Day/Month /Year
Permanent Personal Address:____________________________________________________________________________________
Street City State/Province
___________________________________________________________________________________________________________
Zip/Postal Code Country Home Telephone Number Email address
COURSE DOCUMENTATION (Lecture Phase):

Name of Course: _________________________________________________________________ Course Number: ______________
Location of Base: _______________________________ Starting Date (please spell month):__________ Ending Date ____________
City/Country day/month/year day/month/year
Weekly Teaching Topics/Ministry Activities Teacher(s)
1. _________________________________________________________ ______________________________
___________________________________________________________
2. _________________________________________________________ ______________________________
___________________________________________________________
3. _________________________________________________________ ______________________________
___________________________________________________________
4. _________________________________________________________ ______________________________
___________________________________________________________
5. _________________________________________________________ ______________________________
___________________________________________________________
6. _________________________________________________________ ______________________________
___________________________________________________________
7. _________________________________________________________ ______________________________
___________________________________________________________
8. _________________________________________________________ ______________________________
___________________________________________________________
9. _________________________________________________________ ______________________________
___________________________________________________________
10. ________________________________________________________ ______________________________
___________________________________________________________
11. ________________________________________________________ ______________________________
___________________________________________________________
12. ________________________________________________________ ______________________________
___________________________________________________________
Resource Materials used for the course ( books, videos, articles etc.):___________________________________________________
Historical Course Documentation Form; App'd: Provost Team, Lausanne, July, 1995; Printed April 2, 2012 Page 1 of 2
2005 U of N Reference Guide. Copyright © 1995 by YWAM/U of N; Revised 1997, 2000, 2005, 2011. All Rights Reserved. Page 1
Weekly schedule: number of hours spent per week in the following learning activities:
C Teaching: ______ C Worship: ______
C Specific ministry activities: ______ C Written assignments: ______
C Small groups: ______ C Practical work duties: ______
C Intercessory prayer: ______ C Personal Devotional Times ______
C Tests: ______ C Other types of learning activities: ______
COURSE DOCUMENTATION (Field Assignment/Outreach or Internship Phase):
Name of Course: _______________________________________________ Course Number: ______________________

Location of Outreach:______________ Starting Date (please spell month):______________ Ending Date _____________
City/Country day/month/year day/month/year
Description of Weekly Ministry Activities and Teachers if applicable
1. ___________________________________________________________________________________________________
2. ___________________________________________________________________________________________________
3. ___________________________________________________________________________________________________
4. ___________________________________________________________________________________________________
5. ____________________________________________________________________________________________________
6. ____________________________________________________________________________________________________
7. ____________________________________________________________________________________________________
8. ____________________________________________________________________________________________________
9. ____________________________________________________________________________________________________
10. ___________________________________________________________________________________________________
11. ___________________________________________________________________________________________________
12. ___________________________________________________________________________________________________
Resource Materials used for the course ( books, videos, articles etc.):_______________________________________________
Weekly schedule: number of hours spent per week in the following learning activities:
C Teaching: ______ C Worship: ______
C Specific ministry activities: ______ C Written assignments: ______
C Small groups: ______ C Practical work duties: ______
C Intercessory prayer: ______ C Personal Devotional Times ______
C Tests: ______ C Other types of learning activities: ______
SCHOOL LEADER'S VERIFICATION OF DOCUMENTATION AND EVALUATION OF STUDENT:

Number of times per week when staff and students met together for monitoring/evaluating the student’s progress: ______
School Leader's written verification/signature and appropriate evaluation/assessment of student:
Evaluation of Student: Grade (please circle one grade) A, B, C or Pass or ‘S’(Anything below a “C” is not transferrable)
School Leader/Staff: ___________________ _____________________________________________________________
Name Verification signature Date: day/month/year
Please send the completed form along with the US$ 25.- registration fee for a DTS/CDTS to the YWAM/U of N DTS Centre –
PO Box 1031 – Sun Valley 7985 – South Africa. Email address: p.lee@uofn.edu or for a Post-DTS/CDTS course please send the
form to the appropriate International Dean of the College/Faculty of the student’s degree programme (Please see the current U of N
Catalogue or Reference Guide for addresses).
*************** FOR OFFICE USE ONLY: DO NOT WRITE BELOW THIS LINE ***************
US$ 25 Fee received:____ Notification sent to: College/Faculty ____ Regional Records Office _____ Provost Office _____
International Dean of the College/Faculty_________________________________________________ Credits Recommended: _____
or Centre Director nearest to the course: Approval Signature Date: day/month/year
International Dean of the College/Faculty:_____________________________________________________Credits Assigned _____
of the degree programme Approval Signature Date: day/month/year
Provost: ______________________________________________________________________________ Credits Approved_____
Approval Signature Date: day/month/year
Historical Course Documentation Form; App'd: Provost Team, Lausanne, July, 1995; Printed April 2, 2012 Page 2 of 2
2005 U of N Reference Guide. Copyright © 1995 by YWAM/U of N; Revised 1997, 2000, 2005, 2011. All Rights Reserved. Page 2

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U OF N HISTORICAL COURSE DOCUMENTATION FORM

PURPOSE STATEMENT and PROCEDURAL EXPLANATION:

Student's Legal Name_:_________________________________________________________________________________________

COURSE DOCUMENTATION (Lecture Phase):

COURSE DOCUMENTATION (Field Assignment/Outreach or Internship Phase):

Name of Course: _________________________ Course Number:

SCHOOL LEADER'S VERIFICATION OF DOCUMENTATION AND EVALUATION OF STUDENT:

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