Disaster Relief Chaplaincy Application

First Name

MI

Last Name

Sex

MaleFemale

Date of birth

Address, City, State, Zip Code

Email

Cell Phone Number

Ordination Status (Not Required to be a Chaplain)

LicensedOrdainedLayperson

I am

SingleMarriedDivorcedWidowed

Home Church Name (Must be a Florida Baptist Convention Church)

Senior Pastor's Name

City, ZIP

Name of local church Association:

Are you serving in a Chaplaincy role? (Professionally or Volunteer)

YesNoCareerVolunteer

If yes, where?

Have you taken any of the following courses?

FL DR Chaplaincy Course (Half Day in Person)CISMOSFANone

If yes, please attach copies of your certificates of completion

List special training or skills you possess:

Please describe your personal testimony about Jesus Christ and how He changed your life:

Please describe how are you currently sharing your faith and discipling others:

Briefly state your reason for wanting to be a Disaster Relief chaplain. Keep in mind the Chaplaincy is a calling and not something you age into:

Signed

Date

*REQUIRED
I affirm that I am a member in good standing of a Southern Baptist Convention church in the state of Florida. I also affirm that I will be able to secure a written recommendation from my senior pastor for service as a DR Chaplain as needed by the application process. I also affirm that I agree with the Baptist Faith and Message 2000 and will uphold the Baptist tradition of faith and practice.

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