Disaster Relief Chaplaincy Application

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    Disaster Relief Chaplaincy Application

    Name

    Sex
    MaleFemale

    Date of birth

    Address, City, State, Zip Code

    Email

    Phone Number

    I am

    I am

    My Church Membership, City

    Name of Association or Disaster Relief Region:

    Are you serving in a Chaplaincy role?
    YesNoCareerVolunteer

    If yes, where?

    Have you taken any of the following courses?
    DR Chaplaincy CourseCISM or Stress First AidSpiritual Care (Barnabas)

    List special training or skills you possess:

    Describe your initial encounter with Jesus Christ and relate how he continues to change your life:

    How are you currently involved in sharing your faith?

    Briefly state your reason for wanting to be a Disaster Relief chaplain:

    Signed

    Date

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