Advanced Lay Ministries SAM Expanded Application August 2025

Expanded Application for the NC Synod SAM Certification Program
First Name*
Middle Name*
Last Name*
Last Name at birth (if different)
Address*
City*
State*
Zip*
Email*
example@example.com
Home Phone*
Format: (000) 000-0000.
Cell Phone*
Format: (000) 000-0000.
Gender*
Preferred Pronouns*
Birthdate*

MonthDayYear
Date
Birthplace*
Baptism Date*

MonthDayYear
Date
Congregation in which you were Baptized *
Location*
Citizenship*
Ethnic Origin
Are you legally entitled to work in the United States?*
First Language*
Other Languages
ELCA Congregational Membership
Congregation Name*
Address*
City, State, Zip*
Member Since*
What is your involvement in your congregation?*
Pastor's Name*
Pastor's Email*
example@example.com
Cell Phone*
Format: (000) 000-0000.
Family Information

Spouse
Marital Status*
Marriage Date

MonthDayYear
Date
First Name of Spouse
Middle Name of Spouse
Last Name of Spouse
Last Name at birth (if different)
Birthdate

MonthDayYear
Date
Religious Affiliation
Church Membership
Education and Profession
Rostered in the ELCA?
Children
I have no children
Child's Name
Birthdate

MonthDayYear
Date
Do they live with you?
Child's Name
Birthdate

MonthDayYear
Date
Do they live with you?
Child's Name
Birthdate

MonthDayYear
Date
Do they live with you?
Child's Name
Birthdate

MonthDayYear
Date
Do they live with you?
If you have more than 4 children, please list their names, birthdays, and if they live with you in the space provided below.
PREVIOUS SPOUSE(S):
I have no previous spouses
Name
Date of Marriage

MonthDayYear
Date
Date marriage ended

MonthDayYear
Date
Marriage ended by
Name
Date of Marriage

MonthDayYear
Date
Date Marriage ended

MonthDayYear
Date
Marriage ended by
Post- Secondary Education
I have no post-secondary education.
Name
Major/studies
Years (From/To)
Degree
City, State
Name
Major/studies
Years (From/To)
Degree
City, State
Name
Major/studies
Years (From/To)
Degree
City State
Name
Major/studies
Years (From/To)
Degree
City State
Work History

Please list most recent position first, including military service.
Employer
Position/Title
Years (From/To)
City, State
Phone
Format: (000) 000-0000.
Employer
Position/Title
Years (From/To)
City State
Phone
Format: (000) 000-0000.
Employer
Position/Title
Years (From/To)
City, State
Phone
Format: (000) 000-0000.
Employer
Position/Title
Years (From/To)
City, State
Phone
Format: (000) 000-0000.
Employer
Position/Title
Years (From/To)
City, State
Phone
Format: (000) 000-0000.
Identify professional certifications or licensure in any specialization.
Candidacy Questions
As a Synod Authorized Minister, I understand that I will be held accountable to the synod's bishop and the ALM Leadership Team regarding "this church's expectations for my speech and conduct as set forward in Definitions and Guidelines for Discipline of Rostered Ministers." I understand that my ministry as a SAM brings increased attention to my life. I am responsible for informing my bishop regarding any circumstance that might subject me to discipline according to Definitions and Guidelines were I a rostered minister, I understand that the bishop and ALM Leadership Team may modify my participation status in response to my speech and conduct.

Please answer "yes" or "no" on the following questions. If you answer "yes", please explain in the box below the chart.

Rows	Yes	No
Do you belong to any organization or lodge like the Free Masons or Eastern Star which claim to possess in its teachings and ceremonies that which the Lord has given solely to the Church?
Do you have or have had any health conditions (physical or psychological) that might interfere with your ability to serve as a Synod Authorized Minister?
Are there issues in your family situation or personal life that could adversely affect your ability to serve as a Synod Authorized Minister?
Is your personal debt, excluding mortgage, greater than $31,500?
Have you ever defaulted on a loan or declared bankruptcy?
Do you engage now, or have you engaged in any addictive behavior, including drug or alcohol abuse, or sexual or pornographic addictions?
Have you ever been terminated or resigned from any employment or volunteer activities due to accusations of misconduct, whether financial, sexual, ethical, or other improper behavior?
Have you ever engaged in, been accused or charged with, or convicted of a crime, or illegal conduct, including conduct resulting in suspension or revocation of your driver's license?
Have you ever been engaged in, accused of, sued, or charged with sexual molestation, sexual harassment, child neglect or abuse, spousal neglect or abuse, or financial improprieties?
Do you have any sexual attraction toward children or minors, or any history of sexually deviant behavior, including behavior with children or minors?
Have you engaged in any behavior or been involved in any situations that, if they became known by the church, might seriously damage your ability to continue preparing to become a SAM or serving as a SAM?
Is there additional information that would assist the SAM Leadership Team in considering your application or that you believe the Leadership Team should know?

If you answered yes to any of the above questions, please use this place to explain.
Entrance Essay
The entrance essay is an autobiographical reflection which should contain insights and understandings gained during the period of discernment and your formation so far affect your decision to apply to be a Synod Authorized Minister in the North Carolina Synod. It is not expected that your discernment is completed. You are asked only to provide an honest assessment of your current self-understanding of your journey thus far and your hope for the future. Your essay will provide the Advanced Lay Ministries Leadership Team background information that will help guide your interview.

For each of the three parts, write 2-3 pages in length, double spaced with 12 pt. font. You will be able to upload your essay before you submit this form.

As you reflect on your formation thus far:
1. Describe your journey of discernment. Where did you hear about Synod Authorized Ministry? How did you first experience a call to pursue this form of lay ministry? With whom have you discussed this sense of call? Through this intentional time of discernment, what have you learned about yourself, the church, and the world?
2. What gifts or skills has God given you which will enrich your ministry as a SAM? Describe your worship leadership experience and how this will prepare you to serve as a SAM.
3. How do you see yourself serving as a SAM? Describe your ideal context. What is your leadership style and how you will walk alongside congregations? What challenges might you anticipate encountering in ministry?
Please upload your Entrance Essay here.*

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Reference
Provide the appropriate reference form to your pastor and congregation council. Yes, they've already submitted one for your entrance to the Advanced Lay Ministries program. Now we need to determine their support for you as you continue your preparation. References may be submitted through email.
Signature
By checking this box I state that the information in this application is true and correct. I hereby apply for entrance into the process for becoming a Synod Authorized Minister.
Signature*
Date

MonthDayYear
Date
Printed Name*
By submitting this form, you will be sending your information to Deacon Wendy Roberts; however, if you would like to send a hard copy, you can send it to:

Deacon Wendy Roberts
1988 Lutheran Synod Drive
Salisbury, NC 28144
wroberts@nclutheran.org
SAM Authorization and Release
I authorize any references, supervisors, ELCA agencies, congregations, or any other person or organization to give any information, including opinions, regarding my character and fitness for ministry to the ALM Leadership Team of the North Carolina Synod, ELCA. I also release any individual, employer, church, reference, or any other person or organization providing information from any and all liability for damage of whatever kind of nature that may exist at any time on account of compliance or any attempts to comply with this authorization, excepting only the communication of knowingly false information. An email attachment of this signed form, a facsimile or photocopy of this authorization shall be as valid as the original.
Signature*
Date

MonthDayYear
Date
Printed Name*
Should be Empty:

Expanded Application for the NC Synod SAM Certification Program

ELCA Congregational Membership

Family Information

PREVIOUS SPOUSE(S):

Post- Secondary Education

Work History

Candidacy Questions

Entrance Essay

Reference

Signature

SAM Authorization and Release