Annual Endorsement Renewal

Chaplain Annual Endorsement Renewal

This form is for chaplains who currently hold an endorsement from the Florida Multicultural District. Please update your information and confirm whether a new background check is required before submitting your annual renewal.
Type
Applicant Information
Chaplain ID Number
Chaplain’s Full Name

First NameLast Name
Chaplain’s Email
example@example.com
Chaplain’s Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Text Message Consent
Chaplain’s Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code
Last Four Digits of Your Social Security Number
Enter only the last four digits of your Social Security number. These digits will be used as the number assigned to your FMD chaplain badge. Do not enter your full Social Security number.
Current Ministry Information
Church Name
Church City and State
Which FMD section is your church affiliated with?
Senior Pastor's Full Name

First NameLast Name
Senior Pastor's Email Address
example@example.com
Senior Pastor's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name of the organization or institution where you currently serve as a chaplain
Your current chaplaincy role or position
FMD Ministerial Credentials
Are you currently a credentialed minister with the Florida Multicultural District?
Credential Level
Background Check
Have you completed a background check through our organization within the last 24 months?
Total Due (USD)
New Background Check Required

Please complete your background check using the link below. A $25 background check fee will be added to your $25 annual renewal fee. Your total payment in this form will be $50.

Complete the Background Check Here >
Background Check Confirmation
Please contact the Missions Resource Center before submitting your renewal to confirm whether a new background check is required. You can reach us at missions@fmdag.org or (407) 850-9861.
Certification and Payment
Certification

Should be Empty:

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

Chaplain Annual Endorsement Renewal

Applicant Information

Current Ministry Information

FMD Ministerial Credentials

Background Check

New Background Check Required

Complete the Background Check Here >

Please contact the Missions Resource Center before submitting your renewal to confirm whether a new background check is required. You can reach us at missions@fmdag.org or (407) 850-9861.

Certification and Payment

Payment Amount*

Payment Amount