Licensed Lay Ministry Application
For lay leaders interested in applying to participate in the LLM (Licensed Lay Ministry) formation path of the NEPA Synod of the ELCA.
Your Information
Today's Date
*
-
Month
-
Day
Year
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
Cell Phone Number
Email Address
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Your Congregation/Ministry Site Information
Name of Congregation/Ministry Site
*
Name of Current Pastor
First Name
Last Name
Is this Pastor:
Permanent
Interim
Designated
Pulpit supply
Address of Congregation/Ministry Site
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number of Congregation/Ministry Site
*
Please enter a valid phone number.
Email Address for Congregation/Ministry Site
example@example.com
How long have you been a member of this congregation/ministry site?
*
# of years
Are you interested in being a LLM as part of a 6261 Ministry Community?
*
Yes
No
Possibly in the future
Not sure
Employment Information
Employer Name
Employer Phone Number
Please enter a valid phone number.
Employer Email
example@example.com
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you worked for this employer? How many hours per week do you work? Please share your employment plans while you participate in the LLM formation path.
May we contact your Employer for a reference?
Yes
No
Additional Information
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Please share any food allergies, mobility concerns, or other information we should know when scheduling retreats, meals, etc.
*
Is there anything else you would like us to know or to take into consideration?
Signature
*
Math Challenge
*
Continue
Continue
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