CPM Form 1A: Application to be Enrolled by Presbytery as an Inquirer

CPM Form 1A: Application to be Enrolled by Presbytery as an Inquirer

PC(USA) Form; Revised February 2012
Date*

MonthDayYear
Name of applicant*

First NameMiddle NameLast Name
Current address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Main phone*

Area CodePhone Number
Phone type*
Alternate phone

Area CodePhone Number
Phone type
Email*
example@example.com
Permanent address (if same, write same)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender*

FemaleMale
Date of birth*
Race/Ethnicity*

AsianBlackCaucasianHispanicKoreanMiddle EasternMulti-racial/EthnicNative AmericanOther
Current church membership*
Date received as member*
Number of members
Have you ever applied to a presbytery to be enrolled as an inquirer or candidate?*

YesNo
If yes, was enrolled as
In what presbytery?
From
to
In what church occupation are you interested in at this time?*
(e.g. pastor, youth minister, mission worker, educator)
Present or most recent school attended*
Location*
Date of Graduation

MonthDayYear
Applicant's Statement
I hereby apply to be enrolled by __________ Presbytery as an inquirer.*
(name of presbytery)
Certification*

I certify no civil, criminal, ecclesiastical complaint has ever been sustained or is pending against me.I am unable to make the above certification. I offer instead on the attachment a description of the complaint and/or outcome of the situation with explanatory comments.
Upload description of the complaint and/or outcome of the situation with explanatory comments here.

Browse Files

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I certify that the above statement and other information in this application are true and correct. I promise to participate diligently and wholeheartedly with the session and the presbytery in exploring my vocation.*
Family Situation
Current marital status*

SingleMarriedSeparatedDivorcedWidowed
Ages of any children in the home
Are you and your household members open to the possibility of relocation in conjunction with theological studies and/or accepting a ministry position?*

YesNo
If you are limited in your ability to relocate, please describe on the following lines
Church Background
Year of baptism*
Year of your confirmation/profession of faith

Most recent affiliations (include up to three):

	Church name	Dates of participation (MM/YYYY-MM/YYYY)
1
2
3

Have you been ordained as a ruling elder in the PCUSA?*

NoYes
Date
Have you been ordained as a deacon in the PCUSA?*

NoYes
Date
Have you been ordained in another denomination?*

NoYes
Date
If yes, name of denomination
Office

List up to five areas of involvement in the life and mission of the church, either as a participant or leader, that are most significant in your sense of call to the role of teaching elder. Mark current involvements with an asterisk.*

	Area of involvement	Participant or leader
1
2
3
4
5

Academic Information

List the academic institutions you have attended, beginning with college, and supply the information requested in each column. If you are currently pursing an educational program, indicate your academic classification in the final column.*

	Name of Institution	Dates attended	Program/major	GPA	Diploma/degree
1
2
3
4

Briefly describe your academic interests/gifts by completing the following table.*

	Subjects in which you did your best academic work	Subjects in which you did less well
College
Graduate school
Professional school
Other training

Have you ever had an individualized educational program (IEP)?*

YesNo
If yes, what accommodations did the IEP include?
List your academic honors, awards, special recognition, sports, organizations and extracurricular activities that have been most meaningful.
Occupational History

Beginning with your current or most recent position, list all full-time or part-time jobs in which you have been employed. Include the five most recent, up to the last 20 years. Place a "PT" beside the title of part-time jobs.*

	Job Title	Dates	What did you enjoy most?	What did you enjoy least?
1
2
3
4
5

References
References should include at least two of the following: someone from your church, a former employer, a peer, or a former professor or school administrator.
Name*

TitleFirst NameMiddle InitialLast Name
Current address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred phone number*

Area CodePhone Number
Email*
example@example.com
How long have you known this person and in what capacity?*
Name*

TitleFirst NameMiddle InitialLast Name
Current address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred phone number*

Area CodePhone Number
Email*
example@example.com
How long have you known this person and in what capacity?*
Name*

TitleFirst NameMiddle InitialLast Name
Current address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred phone number*

Area CodePhone Number
Email*
example@example.com
How long have you known this person and in what capacity?*
Should be Empty:

CPM Form 1A: Application to be Enrolled by Presbytery as an Inquirer

Applicant's Statement

Family Situation

Church Background

Academic Information

Occupational History

References