Credential Inquiry Level of Credential You Are Seeking * Certified Licensed Ordained Unsure Credential Type * New Upgrade Reinstatement First Name * Middle Name * Last Name * Date of Birth * MM DD YYYY Biological Sex * Female Male Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Cell Phone * (###) ### #### Email * Church * Briefly list any ministries you are involved in * Are you currently credentialed with another religious organization? If so, what organization? Have you met the education requirements for the credential level you are seeking (see credential information)? * Yes No Unsure If "no" to the previous question, have you completed any of the credential level educational requirements? Yes No Unsure Other Education Please list other religious or secular degrees or education you have completed: Have you been Baptized in the Holy Spirit with the Evidence of Speaking in Tongues? * Yes No Unsure Briefly explain why you are seeking credentials * Are any of the following in your history: bankruptcy, foreclosures, tax liens, judgements, collections (may or may not be disqualifying factors)? * Yes No Marital Status * Married Single Widowed Have you or your spouse been divorced (does not automatically disqualify you)? * Yes No N/A If "yes" to the above, are you or your spouse remarried (does not automatically disqualify you)? * Yes No N/A Comments Thank you!
