Application for Leadership Development Scholarship

The 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 for the cost of obtaining a Background Check. If completing this Application to serve as a Regional Pulpit Supply Minister, please see the Pulpit Supply Policy for more information on requesting a Background Check.

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

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

Your Regional Minister*

Regional Minister's Email*

Paul@ccmadisciples.org or David@ccmadisciples.org

Requesting Scholarship for:*

Background CheckBackground Check for Pulpit SupplyOther

If Other, please specify:*

Reimbursement Amount:*

Please provide the exact amount to be reimbursed.

Receipt*

Please upload a copy of your paid Receipt here.

Applicant's Signature*