MUSLIM CHAPLAIN ENDORSEMENT FORM
All forms will be reviewed by ILM Muslim Chaplain Endorsement Committee - info@humanitarianday.com / 213-986-6820
CONTACT INFORMATION
Date
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Month
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Day
Year
Date
Full Legal Name (as appears on State ID or Passport)
Date and Place of Birth
Social Security Number
Full Address: Street, City, State, and Zip Code
Phone Number
Email Address
Are you a practicing Muslim?
Yes
No
Are you a naturalize citizen of the United States of America?
Yes
No
University Education & Imam and or Islamic Teaching Experience
List below in order: Name of University, location, dates attend , degree, graduation date.
If you prefer - upload your education experience below:
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Imam Experience: name of Masjid or Center, address, website, email, phone, start and end date of work experience, and list of responsibilities.
List your references below: Name, institution, position, phone, and email.
If you prefer - upload your work CV or resume below:
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Chaplaincy Information
Are you apply for endorsement with the Federal Bureau of Prisons?
Yes
No
Although not available through ILM, are you interested in a branch of military endorsement for example: Army, Navy, National Reserves?
Yes
No
Muslim Chaplain Candidate Question
Why do you want to be a Muslim Chaplain in the Federal Bureau of Prisons?
Additional Comments
Jazak Allahu KhayrILM Foundation
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