Penn York DBMD 01 - Personal Data Inventory

Penn York DBMD 01 - Personal Data Inventory

This inventory is designed to introduce you to your district board of ministerial development (DBMD) and inform them concerning your present situation as you apply for district ministerial standing. You are expected to fill out the inventory frankly and carefully in order that the DBMD might know you and your background better and thereby assist you in your progress toward ministerial credentials. It is your responsibility to answer all questions as they apply to your situation.
Identification Data
Full Name *

Prefix First Name Middle Name Last Name Suffix
Email Address *
example@example.com
Gender *

Female Male
Birthdate *

Month Day Year
Date
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Physical Address (if different than mailing)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Cell Phone Number (if applicable)

Area Code Phone Number
Home Phone Number (if applicable)

Area Code Phone Number
Social Security Number *
Are you a legal citizen of the United States? *

Yes No
If you are not a legal US citizen, please explain.
Military record (if applicable)
Family Relationships
How many children are in your parent's family? *
Which position are you? *
Briefly survey your childhood home environment, parents' relationship to each other, affection in the home, and your religious training/upbringing. *
Are your parents living? *

Father Mother Both
Father's full name *

First Name Last Name
Mother's full name *

First Name Last Name
Parent status *

Divorced Remarried
Are your parents professing Christians *

Father Mother Both
Which denomination is eaach a member (if any)? *

What is your family's attitude toward the prospect of you entering the ministry? *

	1	2	3	4	5

1 is Supportive, 5 is Opposed

Marital Status
Current status *

Single Dating Engaged Married Widow(er)
If 'single', or 'dating' are you contemplating marriage? *
If engaged, what is the planned date of marriage? *
If engaged, please list fiance's name, birth date, and SSN *
Is your fiance a citizen of the United States? *

Yes No
If no, please explain *
Explain any hesitancy or resistance your spouse or fiance may have with your desire to become a minister. *
If married, please list spouses name, birth date, and SSN *
Is your spouse a citizen of the United States? *

Yes No
If no, please explain *
Date of marriage

Month Day Year
Date
Spouse's education *
Are you and your spouse maintaining a life of sexual purity and faithfulness in your marriage covenant? *

Yes No
Have you or your spouse ever been involved in sexual activity with a minor? *

Yes No
Are you now living with your spouse? *

Yes No
If not, please give explanatory statement.

Family Dependents
Number of children
Please list children's names, genders, birth dates, whether they're currently living as your legal dependent, etc.
Other dependents
Health Information
Do you have chronic illnesses or physical defects? *

Yes No
If so, please state the nature of these.
Have you ever had any serious illness(es)? *

Yes No
If yes, please state the nature of the serious illness(es)
Have you ever had any serious emotional problem(s)? *

Yes No
If yes, please state the nature of the emotional problem(s)
What do you consider your present state of health to be? *

Other Personal Data
Give names of all patriotic, civic, social, fraternal, or athletic societies to which you currently belong or have belonged. *
Have you ever been a member of any organization commonly considered politically subversive? *

Yes No
If yes, please give explanatory statement.
Have you ever been a user of tobacco, alcohol, or other harmful drugs? *

Yes No
If yes, explain how you were delivered from such uses
What is your attitude toward the above practices or other personal habits which are injurious physically or hurtful to one's influence? *
Have you ever been convicted of, or pled guilty or "no contest" to, any criminal offense? *

Yes No
If yes, explain fully by identifying each conviction or plea of guilt, when and where each incident occurred, and the sentence(s) received.

Educational Record
High School - (name(s), dates attended, degree or certificate) *
If you have a high school equivalency diploma, give number and year of issue
College - (name(s), dates attended, degree or certificate) *
Seminary or Graduate School - (name(s), dates attended, degree or certificate) *
Other *
Are you now enrolled or do you plan to enroll in one of our Wesleyan colleges or one of the approved seminaries? *

Yes No
Have you completed any part of the pre-ordination/commissioning courses or study? *

Yes No
If yes, which course(s)?
Are you aware of the academic requirements for ordination/commissioning and if licensed by this district, is it your purpose to pursue immediately the course(s) of study and be ordained/commissioned? *

Yes No

Closing Statement & Signature

Please enter your initials after each of the following statements. Your initials serve as your digital signature of this form.
I understand that ordination/commissioning by The Wesleyan Church is a privilege granted me, not a right that I claim. I hereby acknowledge the authority of the Church in granting ordination/commissioning to those who, after thorough examination, are believed to have the gifts, graces, fruit and call of God. Further, I understand that though I may complete all of the academic requirements for ordination, it does not guarantee my ordination/commissioning. *
I hereby freely give permission for the use of this information by the district and general officials of The Wesleyan Church and waive my right to examine any confidential information about me provided by other persons. *
Please enter your full name as a secondary digital signature before submitting this completed form *
Date this form was completed *

Month Day Year
Date
Signature

Clear
Should be Empty:

Penn York DBMD 01 - Personal Data Inventory

Identification Data

Family Relationships

Marital Status

Family Dependents

Health Information

Other Personal Data

Employment and Finances

Educational Record

Religious Experiences and Church Relationship

Closing Statement & Signature