Volunteer Chaplain Application

Volunteer Chaplain Application

Volunteer Chaplain Application

For Volunteer Chaplain's License
To obtain or renew a Christian Prisoner Ministry (CPM) Volunteer Chaplain License:

1. One must be affiliated with the United Pentecostal Church International in some way. Attend a UPCI church with a licensed UPCI pastor that would recommend and sign the application. If not attending a UPCI church, have knowledge of a UPCI pastor that would sign the application and you be accountable to.

2. Complete the 4 hours of required training for Volunteer Chaplaincy either online at Ministry Central or at a District, Regional or National CPM Conference. The registration fee is $50.

3. For a one-year license, please remit $35 upon completing this application. You may purchase a two-year license for $55. At the end of this application, you will be redirected to the payment page for this non-refundable fee to be paid. You may also process your application payment by calling our office at (636) 229-7905.

4. If you have any questions, please feel free to contact our office at (636) 229-7905 or email at CPM@upci.org.
Personal Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age*
Gender*

MaleFemale

Certification Information
Certification Type*

Volunteer ChaplainVolunteer Chaplain Renewal
Certification Term*

1 year ($35)2 year ($55)
Name of the institution for which you desire Chaplain Credentials:
Name
Address of the institution:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Church Information
Church Name*
Name
Church Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pastor's Name*

First NameLast Name
Pastor's Email*
example@example.com

More Personal Information
If you are a Licensed Minister with the UPCI, please select which type:*
Do you fully understand that the Prison Chaplain License does not give you ministerial credentials with the UPCI, and that the license is valid only while ministering in the jails and prisons of your area?*
Are you presently active in prison/jail ministry?*

Required Files
Please provide a current photo of yourself*

*This photo will be used in the printing of your badge.
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Certificate of Completion: Volunteer Chaplain Training *

*This is provided to you in digital format upon completing the training in Ministry Central.
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Signatures
Applicant's Signature*

Clear
Date*

MonthDayYear
Date
***Policy Requirement - Pastoral Signature***

In order to have your application processed, you MUST have your pastor's signature, and they MUST have credentials with the UPCI. Upon submitting your application, a request for review and signature will automatically be sent to your pastor, via the email you provided on this form. It is your responsibility to follow up with your pastor to obtain their signature.
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