CHURCH REVITALIZATION APPLICATION
Kentucky District Council of the Assemblies of God, Inc.
Your Name
Spouse's Name (if applicable)
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone
Home Phone
Email Address
example@example.com
Name(s) and age(s) of Children, if applicable
Please submit a recent photo of yourself (and your spouse, if applicable)
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Church Name
Church Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Section
Please Select
Bluegrass
Central
Cumberland
Jackson Purchase
Louisville
Mountain
North Central
Northeast
Northern
Pennyrile
Red River
South Central
Presbyter
Church website
Average current Sunday attendance
Write a detailed overview and assessment of your journey as pastor ofyour current church and what your vision is for the congregation for the next five years (several paragraphs recommended).
Signature
Date
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Month
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Day
Year
Date
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