Application for Leadership Development Scholarship

Christian Church (Disciples of Christ) of Mid-America

Application for Leadership Development Scholarship

The Leadership Development Scholarship Program was designed to provide financial assistance to our Ministers with the cost for obtaining a Background Check through Oxford Document Management Company, either directly through their Website or the Disciples Home Missions (DHM) Min Pro System. Reimbursement for this Scholarship will be provided upon submission of payment and receipt.

Please contact your Ministry Associate in the CCMA Springfield Regional Office with questions directly at sgf@ccmadisciples.org. Thank you so much!

Name*

First NameMiddle NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Home Address (This is where your check will be mailed.)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Your Regional Minister*

Paul KochRon RoutledgePhil SniderDavid Woodard

Regional Minister's Email*

Paul@ccmadisciples.org; Ron@ccmadisciples.org; Phil@ccmadisciples.org; David@ccmadisciples.org

Requesting Scholarship for:*

Background CheckBackground Check Specifically for Pulpit SupplyOther

If Other, please specify:*

Reimbursement Amount:*

Please specify the exact amount to be reimbursed.

Please upload a copy of your paid receipt here.*

Please sign your name below in acknowledgement of this Application.*