PERSONAL INFORMATION:

     FULL NAME

    BIRTH DATE

MARITAL STATUS Single Married Divorced Remarried Widowed

       ADDRESS

          CITY

STATE/PROVINCE

   POSTAL CODE

       COUNTRY

    HOME PHONE

    WORK PHONE

 EMAIL ADDRESS

     FINANCIAL I am current with my obligations I am not current with my obligations

         LEGAL No convictions in my past I have been convicted of a misdemeanor I have been convicted of a felony

PLEASE LIST SPOUSE AND DEPENDENT(S):

CHURCH INFORMATION:

CURRENT OCCUPATION

CHURCH AFFILIATION

       CHURCH NAME

    CHURCH ADDRESS

MINISTERIAL INFORMATION:

     YOUR MINISTRY Pastor Associate Pastor Assistant Pastor Teacher Missionary Music Ministry Christian Educator Youth Minister Children's Minister Lay Minister Evangelism Other (HIGHLIGHT ALL THAT APPLY)

 CURRENT LICENSING None Local General Ordination Missionary Worker Lay Minister Other

OTHER ORGANIZATIONS OR CHURCHES YOU HAVE HELD CREDENTIALS:

WHAT LICENSING LEVEL ARE YOU INTERESTED IN?  Conditional General Ordination

REFERENCES:

PLEASE LIST 3 REFERENCES:
NAMES, ADDRESSES, TELEPHONES, AND REFERENCE INFORMATION
(i.e. years known, affiliation, etc.)

EDUCATION:

HIGH SCHOOL

COLLEGE/UNIVERSITY
Please list all previous Undergraduate/Graduate work as well as any courses you may have attended. List any certificates you may have been awarded. Finally list any degrees that you have earned and the year they were awarded.

EXPERIENCE:

Please list any life experience you have in ministry
(such as Pastor, Music Ministry, Evangelism, Elder, Deacon, etc.)
If you were referred by a friend, be sure to mention them here!

BRIEFLY SHARE WITH US HOW YOU CAME TO A SAVING KNOWLEDGE OF THE LORD JESUS CHRIST:

SUBMIT YOUR APPLICATION: