Ordained, Licensed, Credentialed Lay and Ministerial Student Contact Information Form
This form is to be filled out by all Ordained, Licensed, Credential Lay and Ministerial Students of the NC EAST DISTRICT.
This information is provided to the Denomination as an official record of your credentialed status as a minister or student of The Wesleyan Church. Thank you.
TODAY'S DATE *
MM
/
DD
/
YYYY
FIRST Name *
Your answer
MIDDLE Name *
Your answer
LAST Name *
Your answer
Suffix
Date of Birth *
MM
/
DD
/
YYYY
Marital Status *
District Credentials *
Primary Email *
Your answer
Cell Number *
Your answer
Home Number - If Changed
Work Phone Number - If Changed
Home - Street Address *
City *
State *
Zip Code *
Spouse's Name
Your answer
Spouse's Email
Your answer
Spouse's Cell Number (Only kept in Pastor Portal as alternate contact)
Your answer
Church NAME - Where You Are Serving
Your answer
Church CITY- Where You Are Serving
Your answer
Pastoral/Lay Title or Position - currently serving
Additional Position Clarification
Your answer
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