FMD Endorsement Application

Apply for FMD Endorsement

This application is for chaplains who hold a chaplain ID from another institution and wish to apply for endorsement through the Florida Multicultural District. Please have your references and chaplain ID ready before you begin. The application fee is $110. Submission and payment do not guarantee endorsement.
Type
Applicant Information
Applicant’s Full Name

First NameLast Name
Applicant’s Email
example@example.com
Applicant's Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Text Message Consent
Applicant'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 Chaplaincy Service
Name of the organization or institution you belong to
Your current chaplaincy role or position
Name of the institution or ministry where you currently serve
Chaplain ID Number
Church and Pastor 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.
FMD Ministerial Credentials
Are you currently a credentialed minister with the Florida Multicultural District?
Credential Level
What You’ll Need
Please make sure each reference includes the writer’s name, organization, contact information, and signature. Your chaplain ID must be issued by another institution.
Upload a Pastoral Reference

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Upload a Reference from Your Organization

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Upload a Copy of Your Chaplain ID

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Upload a Copy of Your Endorsement Certificate

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Background Check
Background Check Required

Complete your background check using the link below. Once finished, return to this application to submit your Certification and Payment.

Complete the Background Check Here >
Background Check Confirmation
Certification and Payment
Certification

The FMD Chaplain Endorsement application fee is $110. Please complete your payment to submit your application. Applications are reviewed after submission; payment does not guarantee endorsement.

FMD Chaplain Endorsement Application Fee

$110.00

Subtotal

Tax

Total

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

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Apply for FMD Endorsement

Applicant Information

Current Chaplaincy Service

Church and Pastor Information

FMD Ministerial Credentials

What You’ll Need

Background Check

Background Check Required

Complete the Background Check Here >

Certification and Payment

The FMD Chaplain Endorsement application fee is $110. Please complete your payment to submit your application. Applications are reviewed after submission; payment does not guarantee endorsement.*

The FMD Chaplain Endorsement application fee is $110. Please complete your payment to submit your application. Applications are reviewed after submission; payment does not guarantee endorsement.