Page 1 of 1
CHAPLAINCY CERTIFICATION OCTOBER 21st
Register
Date
*
Name
*
Address
*
Phone
*
Email
*
ARE YOU A PASTOR?
*
ARE YOU A PASTOR?
Yes
No
ASSOCIATE PASTOR?
*
ASSOCIATE PASTOR?
Yes
No
ARE YOU A LEADER IN CHURCH?
*
ARE YOU A LEADER IN CHURCH?
Yes
No
IF NOT, WHAT IS YOUR POSITION IN YOUR
CHURCH?
*
DATE OF BIRTH
*
HOW MANY YEARS HAVE YOU BEEN A CHRISTIAN?
*
HOW MANY YEARS EXPERIENCE AS A PASTOR, ASSOC. PASTOR OR LEADER?
*
IF A LEADER, DO YOU HAVE AN LETTER FROM YOUR SENIOR PASTOR TO RECEIVE THESE
CLASSES?
*
IF A LEADER, DO YOU HAVE AN LETTER FROM YOUR SENIOR PASTOR TO RECEIVE THESE CLASSES?
No
Yes
ARE YOU CERTIFIED, LICENSED OR ORDAINED AS A PASTOR OR CHAPLAIN?
*
SS# (This SS No. is needed to do a proper background
check.)
*
You will also receive a separate payment schedule sheet.
Comments
*
SIGNATURE OF APPLICANT
*
Signature
Submit
