SMD Church Planting Application
Thank you for your interest in planting a church in the Southern Missouri District. We are excited to begin this process with you and we will be praying for you as you begin this journey. If you have any questions, please contact the SMD Church Planting Office at 417-881-1316 or at kwilliams@somoag.org.
Personal Information
Full Name
*
First Name
Last Name
Date of Birth
*
Please select a month
January
February
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Month
Please select a day
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Day
Please select a year
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1922
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1920
Year
*
Married
Single
Widowed
Divorced
If married, please list your spouse's full name. If not applicable, please write N/A.
*
First Name
Last Name
If married, please list your wedding anniversary. If not applicable, please write N/A.
*
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
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New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Please list the following information of your children. If not applicable, please write N/A.
*
Names, Date of birth, Living at Home (Y/N)
Parents
*
Name, address, vocation, separated, divorced, or remarried. (Y/N)
Education
If not applicable, please write N/A.
High School
*
Name of High School Attended
Number of Years Attended
*
Graduated?
*
Yes
No
College
*
Name of College/University Attended
Number of Years Attended
*
Graduated?
*
Yes
No
Area of Study/Degree
*
Graduate School
*
Name of Graduate School Attended
Number of Years Attended
*
Graduated?
*
Yes
No
Area of Study/Degree
*
Special Areas of Research or Study
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Ministry
When were you saved?
*
-
Month
-
Day
Year
Date Picker Icon
Where?
*
When were you filled with the Holy Spirit?
*
-
Month
-
Day
Year
Date Picker Icon
Where?
*
What is your current Credential Status?
*
Certified
Licensed
Ordained
I am currently in the process of getting credentialed
I am currently not credentialed
When did you become credentialed with the Assemblies of God? If not applicable, please write N/A.
*
Month, Day, Year
Where did you become credentialed with the Assemblies of God? If not applicable, please write N/A.
*
What is your General Council Credential Number? If not applicable, please write N/A.
*
What church do you attend?
*
Have you discussed this decision with your pastor?
*
Yes
No
Do you have a sponsoring church? If so, please list name and contact person.
*
Ministerial Experience
Please list the church's name's and the positions you were in.
*
Were there any extraordinary circumstances involved in your leaving any of the above positions? If so, please explain.
*
How would you describe the effectiveness or fruitfulness of your ministry?
*
How does your spouse relate to the ministry? If not applicable, please write N/A.
*
How do you see your spouse relating to your projected missionary ministry? If not applicable, please write N/A.
*
Please describe below your normal daily schedule.
*
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Miscellaneous
Please list your present debt obligations in dollar amount totals.
Credit Card
*
School Loans
*
Personal Loans
*
Other
3. What was your total income last year from all sources?
*
Employment
Please describe below your secular employment history.
Previous Employer
*
Name of Previous Employer
Position
*
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Start Date
*
-
Month
-
Day
Year
Date Picker Icon
End Date
*
-
Month
-
Day
Year
Date Picker Icon
Previous Employer
*
Name of Previous Employer
Position
*
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Start Date
*
-
Month
-
Day
Year
Date Picker Icon
End Date
*
-
Month
-
Day
Year
Date Picker Icon
Previous Employer
Name of Previous Employer
Position
Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Start Date
-
Month
-
Day
Year
Date Picker Icon
End Date
-
Month
-
Day
Year
Date Picker Icon
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References
Reference 1
*
Name of Reference
Relationship
*
Years Acquainted
*
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Position
*
Phone
*
Email
*
Reference 2
*
Name of Reference
Relationship
*
Years Acquainted
*
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Position
*
Phone
*
Email
*
Reference 3
*
Name of Reference
Relationship
*
Years Acquainted
*
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Position
*
Phone
*
Email
*
Cover Letter & Resume
Cover Letter
*
Resume
*
Authorization & Release
I affirm the above information to be accurate.
I, ______ of _____, having filled application to become a Church Planter/Development Pastor with the Southern Missouri District of A/G.
*
First Name, Last Name, City & State
Signature
*
Please upload a photo with your application.
*
Submit
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