Status Change Application

Application for Change in Ministerial Credentials

To apply for a Credential Change of Status, please complete entire form. Thank You!
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Personal Information *

First Name Last Name
Email *
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Mailing Address (if different from above)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Cell Phone Number

Area Code Phone Number
Home Phone Number

Area Code Phone Number
Work Phone Number

Area Code Phone Number
Fax Number

Area Code Phone Number
Age
Date of Birth

Month Day Year
Gender

Male Female
Citizenship
Place of Birth
US Social Security Number
Credential Status
Current Elim Fellowship Credential Status
Desired Elim Fellowship Credential Status *
Present activities or other reasons which warrant change of status: *
Christian Experience
A Spirit-filled life includes a life of power, witness, gifts, fruit, and Godly character.
Have you received the Baptism in the Holy Spirit

Yes No
Please tell us your story, regarding your baptism of the Holy Spirit.
Personal References

Christian Worker Applicants for a License to Minister or Ordination must submit at least five (5) references in addition to the interview with the Area Representative. The references should include the applicant's current ministry supervisor and four others. If the applicant is a pastor, another pastor or church leader who knows you well is to be used as "current pastor." If possible, at least one of your references should be an Elim Fellowship credential holder.

For those with License to Minister who are requesting Ordination, we require an Area Rep recommendation and a Pastoral recommendation.

We will send reference forms to each of your references to be returned directly to us.
Pastor *

First Name Last Name
E-mail *
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
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Reference #2

First Name Last Name
E-mail
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Reference #3

First Name Last Name
E-mail
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Reference #4

First Name Last Name
E-mail
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
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Reference #5

First Name Last Name
E-mail
example@example.com
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
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Verification
AUTHORIZATION: I authorize Elim Fellowship to contact any person or employer listed on this application or referenced in the interview process to confirm information supplied by me and or to obtain infomration about my suitability for ministry. I also authorize all listed persons and employers to release any such information and release them from any and all liability for providing that iformation. *

Yes No
If you are unable to check "yes", please explain
WAIVER: I hereby authorize Elim Fellowship to make any investigation of my personal history, credit record and criminal records through any investigative or credit agencies or bureaus of their choice. *

Yes No
If you are unable to check "yes", please explain
NOTICE: Elim Fellowship only grants status changes to those who are members in Good Standing. Being a member in Good Standing requires that credential holders maintain their current credentials, are committed to the mission statement, still adhere to Elim Fellowship's Statement of Faith, continue to support the Core Values, attend area meetings when possible, give their 5% for the C.H.A. and are not under discipline. Do you meet these seven qualifications? *

Yes No
ELECTRONIC SIGNATURE *

Checking this box will authorize your signature
Please print Name Here:
Signature date *
Any other Information we may need:
Should be Empty:

Application for Change in Ministerial Credentials