COM: Appendix 5 – Application for Under Care Status Si necesita este formulario en español, seleccione la bandera española en la parte superior de la página y la página se traducirá al español.First Name *Middle Name (Write n/a if none) *Last Name *Primary Phone *Email *Birth Date *Address (Street, City, State and Zip Code) *Gender *MaleFemaleNon-BinaryPrefer not to answerEthnicity (Choose all that apply) *African AmericanAsianEuropean descentHaitianHispanicMiddle EasternNative American/First NationsOtherPacific IslanderMarital Status *SingleMarriedDivorcedSeparatedWidowedSpouses Name I am a member of the Christian Church (Disciples of Christ) *YesNoName of Church *Phone *Name of Pastor *Address (Street, City, State and Zip Code) *Schools, Colleges, Seminaries, Graduate Schools previously attended: (Please list the most recent first. Include present enrollment and degree program.) *Summary of Work Experience: *My Plans for Ministry *Three Persons whom I will ask to write Reference Letters regarding my candidacy.Name *Phone *Email *Address (Street, City, State and Zip Code) *Relationship to Me *Name *Phone *Email *Address (Street, City, State and Zip Code) *Relationship to Me *Name *Phone *Email *Address (Street, City, State and Zip Code) *Relationship to Me *I understand that my obligation involves continuing communication with the COM and that the Under Care journey does not obligate me to enter the ministry nor does it guarantee that I will be approved for ordination. By entering my name in this box I am signing this form and attest it to be true and accurate to the best of my knowledge. *Email *EmailSubmit
