APPLICATION
PERSONAL INFORMATION
1. Social Security Number (Example: 123-45-6789):
2. Last Name:
First:
Middle:
3. Select your title Mr. Mrs. Ms. Pastor Elder Deacon Evangelist Dr. Reverend Bishop 4. Highest level of education attained Highest Level of Education High School one year college two years of college three years of college associate degree bachelor degree masters degree doctorate
5. Are you licensed or ordained? select one licensed ordained 6. Number of years in fulltime ministry. select nearest number 3 years 5 years 10 years over 10 years
7. Permanent Address:
Number, street, apartment:
City:
State: AA Armed Forces - Americas (excl Canada) AE Armed Forces - Africa AE Armed Forces - Canada AE Armed Forces - Europe AE Armed Forces - Middle East AP Armed Forces - Pacific AL Alabama AK Alaska AZ Arizona AR Arkansas CA California CZ Canal Zone CO Colorado CT Connecticut DE Delaware DC District of Columbia FL Florida GA Georgia GU Guam HI Hawaii ID Idaho IL Illinois IN Indiana IA Iowa KS Kansas KY Kentucky LA Louisiana ME Maine MD Maryland MA Massachusetts MI Michigan MN Minnesota MS Mississippi MO Missouri MT Montana NE Nebraska NV Nevada NH New Hampshire NJ New Jersey NM New Mexico NY New York NC North Carolina ND North Dakota OH Ohio OK Oklahoma OR Oregon PA Pennsylvania PR Puerto Rico RI Rhode Island SC South Carolina SD South Dakota TN Tennessee TX Texas UT Utah VT Vermont VA Virginia VI Virgin Islands WA Washington WV West Virginia WI Wisconsin WY Wyoming
Zip/postal code:
Country: (Leave blank if United States)
8.Your Local/Current Address if different from above:
Local Phone Number (Example: (602) 555-1212):
9.Telephone number:
Daytime (Example: (602) 555-1212):
Evening (Example: (602) 555-1212):
Cell (Example: (602) 555-1212):
10. Your e-mail address:
website address
11. Fax Number: (Example: (602) 555-1212):
12 Sex: Male Female
13 Birth date (Example: 02-14-1945): Age
14. Are you a United States Citizen? Yes No
If no, please complete the following section:
Country of citizenship:
Country of birth:
Country of Permanent Residence:
Are you currently in the U.S.? Yes No
Are you a permanent resident of the U.S.? Yes No
Date Visa Issued (Example:03-1999)
15. Native language, if other than English: What language do you speak at home?