Youth Ministry Certification Program

Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*

Area CodePhone Number
Email*
example@example.com
Birthdate*

MonthDayYear
Date
Age*
Gender*

MaleFemale
Marital Status*
Date Married

MonthDayYear
Date
Spouse Name

First NameLast Name
Please list Child(s) name and ages
Are you a member of the Church of God?*

YesNo
Church Name*
Is this a Church of God congregation?*

YesNo
Lead Pastor's Name*

First NameLast Name
Lead Pastor's Phone Number*

Area CodePhone Number
Church address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your Spouse a member of the Church of God?

YesNo
If yes, where?
Select all that apply*

SavedSanctifiedBaptized in WaterFilled with the Holy Spirit with Evidence of Speaking in TonguesCalled in MinistryConsistent in Church AttendanceConsistent in TithingHave Read Through the Bible
Describe your present ministerial/church activities. Where do you feel most effective in church?*
Place of employment*
How long have you been employed?*
Ministerial Status*

UnlicensedExhorterOrdained MinisterOrdained Bishop
Have you been licensed by another organization?*

YesNo
If yes, give name of the organization and year licensed
Please list any other ministerial experience and training
A confirmation email will be sent that will include a syllabus, required materials for purchase, and the payment link.
Should be Empty: