Request of Status Change from Licensed Credential to Ordained Credential $25.00

Name

Address

This address will receive a confirmation email

Phone

What Church/Ministry are you currently associated with?

Who is someone you are accountable to within that Church /Ministry

Name

Phone

Is your Leadership informed of this request for status change?

Please include below a summary of your current responsibilites and activities in your church/ministry and purpose for status change:

Please note: for status changes not board approved, the $25.00 administration fee for new credentialing cards and certificates will be refunded upon notice.

Payment $25.00

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form and click submit.

Request of Status Change from Licensed Credential to Ordained Credential $25.00

Description

Please Fix the Following