PO Box 28111 Santa Ana, CA 92799 USA. Atten: Admission Dept.
or Email it to
info@esmi-mx.org.



Student Information

Full Name: ________________________________________________________________

Nickname: _________________________________________________________________

Permanent Address: ___________________________________________________________

City: _____________________        State:_____________  Zip:_________ Country:_________

Temporary Address:____________________________________________________________
(if different than above)

City: _____________________        State:_____________  Zip:_________ Country:_________

Telephone: ___________________________ Fax: ____________________________________

E-mail Address:_________________________________________________________________

Birth Date (MM/DD/YY) ___________        Age:        ___________   Gender: _________________

Social Security Number: _______________  Passport No.:_________________ Expt.__________

Nationality: _____________________________ Citizenship: _____________________________

Date of planned arrival in Mexico: __________________________________________________

Do you plan to bring a vehicle? ____________________________________________________
Marital Status:       
 Single   Married    Divorced  Separated   Remarried        

If divorced, separated or remarried, please give the relevant history.
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Spouse Information

Full Name: ____________________________________________________________________

Nickname: ____________________________________________________________________

Permanent Address: ____________________________________________________________

City: _____________________        State:_____________  Zip:_________ Country:__________

Temporary Address:_____________________________________________________________
(if different than above)

City ______________________        State:_____________  Zip:_________ Country:_________

Telephone: __________________________ Fax: ____________________________________

E-mail Address:________________________________________________________________

Birth Date (MM/DD/YY) ___________     Age:        ___________   Gender: _________________

Social Security Number: _______________  Passport No.:_________________ Expt._________

Nationality ____________________________ Citizenship: _____________________________

Is your spouse planning to attend the school also? ___________________________________

What is your anniversary?_______________________________________________________

Children's Names:                                                                        Age                        Gender
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Emergency Contact Information

Contact Name: _____________________________________________________________

Relation to You: _____________________________________________________________

Home Phone: _________________________ Work/Cell Phone: ______________________

E-mail Address: _____________________________________________________________

Ministry or Missions Experience, Education, and Abilities

How many short-term mission trips have you been on? ______________________________

What groups or organizations have you worked with?________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Education (Schools attended and Degrees earned) _________________________________________________
__________________________________________________________________________________________

List your talents, abilities, and gifts that can be useful in the ministry: ____________________________________
__________________________________________________________________________________________

List your weaknesses and the areas in which you need to grow: ________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Are you an ordained or licensed minister? _________________________________________________________

What ministries have you been involved in within your church? _________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

What languages do you speak? (Language and Proficiency 1-10) ______________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Areas of Ministry Interest

In which of the following areas of ministry are you primarily interested and why?

 Church Planting
 Medical Missions
 Teaching English
 Door-to-door Evangelism
 Relationship Evangelism
 Youth Ministry
 Children's Ministry
 Discipleship
 Worship

References

It is our policy to contact your references directly, introducing ourselves as a missions organization, and asking for
their counsel and input regarding your application.  We ask that you have your pastor complete and return directly
to us the Pastor's Reference Form and that you have three other spiritual leaders who know you well submit the
Personal Reference Forms to us.

Does your pastor know that you are sending us this application? ______________________

How does your pastor feel about your desire to work in missions? _____________________

Pastor's Name: _____________________________________________________________

Name of your church: ________________________________________________________

Address ___________________________________________ Denomination: ___________

City: __________________________________        State:  __________      Zip:_________

Your Pastor's Telephone Number: ______________________________________________

Your Pastor's E-mail Address: __________________________________________________

Please list below three people who have a personal knowledge of you and your Christian walk.  (Please give each
of them a Personal Reference Form to complete and send to us.  Forms may be E-mailed to info@esmi-mx.org.)

Name:          ________________________________          Telephone: ________________                

Address: __________________________________________ Denomination: ___________

City: __________________________________        State:  __________      Zip: ________

Occupation: ___________________  Number of Years Acquainted:   __________________               



Name:          ________________________________          Telephone: ________________                              

Address: __________________________________________ Denomination: ___________

City: __________________________________        State:  __________      Zip: ________

Occupation: _____________________  Number of Years Acquainted:__________________                  


Name:          ________________________________          Telephone: _______________                               

Address: __________________________________________ Denomination: ___________

City: __________________________________        State:  __________      Zip: _________

Occupation:   ______________________  Number of Years Acquainted: _______________                 



Finances

Each Training Program student is required to pay tuition of $7200 for the year which covers housing, meals,
utilities, and transportation in Baja Mexico plus a ministry contribution for outreaches.  For your convenience, it can
be paid $600.00 monthly in US dollars (or the equivalent in Mexican pesos) for ten (10) months.  Personal
expenses (toiletries, non-ministry transportation, entertainment, etc.) are not included.

Are you able to cover this amount for the period of time that you plan to work with us? ______________________

If not, how do you plan to raise the necessary funds? ________________________________________________
__________________________________________________________________________________________

Do you have any debt that you will have to raise funds to cover? _______________________________________

What is the debt for and what is the amount? ______________________________________________________

Prayer Support

Upon entering the mission field, you will be fully immersed in spiritual warfare.  It is essential that you have people
who are covering you in prayer.  We suggest that you have a minimum of 20 prayer partners who have committed
themselves to intercede and pray for you, for your ministry, and for the people to whom God sends you.  Start now
to form your team of prayer partners.  Make a list of their names and addresses, so that you can keep them
informed of your work while in Baja.

Christian Life and Calling

Describe your conversion experience and present relationship with the Lord. _____________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

How do you know that God has called you to work in Mexico this next year? _______________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Describe in detail your prior experiences serving as a missionary and/or in your church. _____________________
__________________________________________________________________________________________
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What are your personal and ministry goals for your time in Mexico? _____________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

What are your long-term goals and dreams or calling?  Do they involve ministry or missions?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Personal Application

Have you ever had or do you currently have problems in any of the following areas?  Mark them with a check and
give a detailed description below.

 Lawsuits of any nature
 Civil or military violations
 Experiences with the occult
 Use of illegal drugs and/or alcohol
 Fornication (pre-marital sex)
 Eating Disorder
 Homosexuality or pornography
 Financial Debt
 Stealing
 Psychological Problems/Depression
Details: ____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Describe your reputation; how do you think others see you? ___________________________________________
__________________________________________________________________________________________
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How do you respond when things don't work out as you had planned? ___________________________________
__________________________________________________________________________________________
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How do you respond to the correction by others in your areas of weakness or when you make a mistake?
__________________________________________________________________________________________
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What is your philosophy concerning the suffering of believers? ________________________________________
__________________________________________________________________________________________
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How do you respond in a situation of conflict between you and another person? ___________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
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Please number yourself from 1-10 depending on where you see yourself in the following spectrum (1 being
extreme to the left description and 10 being extreme to the right description).

Compulsion to work  ___________________Slow to put out effort

Challenge authorities ___________________Very submissive

Focus on needs of others ________________Focus on own needs

Extroverted ___________________________Introverted

Firm and consistent _____________________Flexible

Private _______________________________Open

Very Emotional ________________________Very Controlled


Health Information

To the best of your knowledge, have you or your dependents been or are currently being treated for (Check Y or
N):

 Y   N — Condition of the brain or nervous system including epilepsy, fainting, frequent or severe dizziness?

 Y   N —  Any nervous, mental or emotional disorder?

 Y   N —  The respiratory system including tuberculosis, asthma, hay fever, pleurisy, adenoids, tonsils?

 Y   N —  Condition of the heart or blood vessels including abnormal blood pressure, anemia?

 Y   N —  The gastrointestinal tract, liver or pancreas including gallstones, ulcer hernia, rectal trouble?

 Y   N —  The genitourinary organs including kidney trouble, prostatitis, albumin in the urine?

 Y  N —  Cancer, rheumatism, bursitis, arthritis, disorder of the back, varicose veins, breast or female organs?

 Y   N —  Endocrine system including sugar in the urine, diabetes, thyroid, adrenal disorder?

 Y  N —  Any physical deformity or defect including Acquired Immune Deficiency Syndrome (AIDS)?

 Y   N —  Pregnancy?  If yes, estimated delivery date: __________________

 Y   N —  Do you use or have you used tobacco, alcoholic beverages, marijuana or other drugs such as
narcotics, stimulants, depressants or psychometrics?

 Y   N —  During the past 5 years, have you or your dependents had medical consultation, been hospitalized or
are you currently taking medication? If yes, list below:

 Y  N — Do you have any allergies? i.e. Hay Fever, Foods, Medications, Bees, etc.

Record of Consultation
Please list names, injury or illness, date(s), and degree of recovery: ____________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Family Doctor

Name: ____________________________________________________________________

Address: __________________________________________________________________

City _________________________________ State:________ Zip: ______ Country:_______

Phone Number _______________________ Fax Number: ___________________________

Statement of Faith

  1. The Bible, which is verbally inspired by the Holy Spirit in the canonical Scripture as originally given and is the
inerrant and authoritative Word of God. (2 Timothy 3:15-17; 2 Peter 1:21)
  2. The triune Godhead in three persons: Father, Son, and Holy Spirit. (Deuteronomy 6:4; Matthew 28:19;        2
Corinthians 13:14)
          a) The Father, who is Spirit, infinite, eternal, and unchangeable in all his attributes. (John 4:24;
Exodus 34:6)
          b) The Son, Jesus Christ; his deity, virgin birth, sinless life, atoning death, bodily resurrection, personal   
exaltation at God's right hand, and personal return. (John 1:1; Isaiah 7:14; Hebrews 7:26; 1 Corinthians 15:3,4;
Acts 1:11)
          c) The Holy Spirit, who is a divine person, equal with the Father and the Son, and of the same nature. (John
15:26)
  3. The fall and lost estate of man, whose total depravity makes the new birth necessary. (Romans 5:12;
John 3:5)
  4. Salvation by grace through faith in the shed blood and substitution death of Jesus Christ our Lord and Savior.
(Titus 3:4-7; Ephesians 2:8,9; Romans 5:8)
  5. The eternal blessedness of the saved and the everlasting punishment of the lost. (Matthew 25:46; Philippians
3:21)
  6. The Church, the bride of Christ: in its universal aspect comprising the whole body of those who have been
born of the spirit; and in its local expression established for worship, mutual edification, and witness.
(Ephesians 1:22,23; 5:25-32; Acts 15:41; 16,5)
  7. Christ's Great Commission to go into all the world and preach the gospel to every creature, making disciples,
baptizing, and teaching. (Matthew 28:18-20)

I have read the ESMI Statement of Faith.  I am in agreement with it and live according to these tenets of faith.




Signature:  ____________________________________________________________







ESMI   San Ignacio, BCS, Mexico                                                        PO Box 28111  Santa Ana,  CA 92799
Email :
info@esmi-mx.org                                                                    Phone from US :      714-881-1065
                                                                                                         Phone from Mexico: 615-154-0223   
Student Application

ESMI Training Program

SoF ____  R1 ____  R2 ____  R3 ____

Complete     

Approved / Declined ______________