Name:     *

Credential Level:     -Select One-CertifiedLicensedSpecialized LicenseOrdainedSenior Retired          Sex:     -Select One-MaleFemale

My Present Ministry:                       -Select One-PastorEvangelistYouth PastorAssociate PastorOther*

If Other Please Specify:  

District I will be transferring to:  *

Date planning to leave Oklahoma:  *

Name & Location of present church:  *

Oklahoma Address:  *

City/State/Zip:  *       

Oklahoma Phone Number:  *

My new ministry will be:  -Select One-PastorAssociate PastorYouth PastorEvangelistOther*

My new address will be: *

New City/State/Zip: *

New Phone Number: *

VITAL INFORMATION NEEDED FOR RECEIVING DISTRICT

PERSONAL INFORMATION

Place of Birth:  *                        Date of Birth:  *

Social Security Number: *

EDUCATION INFORMATION

Elementary School: 

High School:

A/G College/Institution:

Other College/Institution:

Correspondence Courses (List): 

Were you secularly employed at your last pastorate?  -Select One-YesNo

FAMILY INFORMATION

Spouse
Name: 

Place of Birth:                               Date of Birth: 

Ministry Activity:

CHILDREN
Name:                                          Date of Birth: 

Name:                                          Date of Birth:  

Name:                                          Date of Birth: 

Name:                                          Date of Birth: 

Name:                                          Date of Birth: 

MINISTERIAL HISTORY

Year Credentialed by the Assemblies of God:

District you were Credentialed In:

Credentials from other organizations:

Years Credentialed:

Pastorates/Other Ministries (Type, places, and dates):

DISTRICT COOPERATION

My attendance at district meetings has been:  -Select One-GoodPoor

My promptness in credential renewals, etc. has been:  -Select One-GoodBad

My compliance with district financial policies has been: -Select One-GoodPoor

ADDITIONAL INFORMATION