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Name of Ministry

Applicant’s Full Name

Spouse’s Name (if applicable)

Address

City, State, Zip Code

Home Phone

Work Phone

Date of Birth

Marital Status

Brief Ministry Description

Occupation & Employer Details

Ministerial Calling Synopsis

Willingness to be ordained (Yes/No)

Yes No

Baptism in the Holy Spirit (Date & Experience)

Tobacco, Drugs, or Alcohol Use (Yes/No – Explanation if applicable)

Three Personal/Ministerial References

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