West Virginia District UPCI • North American Missions Dept.
Director: Eugene Whetzel (304) 703-2202 • Secretary: Robert Fazzalore (304) 813-1708
North American Missions ApplicationPage 1 of 4
Date of Application: ______
I desire to start and establish a new church in the area/city of:______
Contact / Family Info:
1. Name:______Age: ______Date of Birth: ______
2. Mailing Address:______City: ______State: ____ Zip: ______
3. Best phones to reach me: ______
4. Email Address: ______
5. Spouse’s Name:______Age: ______Date of Birth: ______
6. Children’s Names & Ages: ______
______
Ministerial Status / History:
7. Present District: ______
8. Superintendent:______Ph: ______Email: ______
9. Presbyter:______Ph: ______Email: ______
10. Pastor:______Ph: ______Email: ______
11. Present Field of Labor (or previous, if moved): ______
Where:______For How Long? ______
12. Other districts in which you have pastored or held license: ______
13. How long have you been in the ministry? ______Local ______General ______Ordained ______
14. Preceding Pastorates: ______
15. Explain your convictions concerning ministerial ethics: ______
______
______
______
______
Calling / Proposed Work:
16. Why are you interested in this city? ______
______
17. When would you be able to move to this city? ______
18. What are the names and locations of the two United Pentecostal Churches nearest to the location of the proposed N.A. Mission Church?
A. Church Name: ______Distance from Proposed Church: ______miles ______minutes
Church Pastor:______City: ______State: ______
B. Church Name: ______Distance from Proposed Church: ______miles ______minutes
Church Pastor:______City: ______State: ______
19. Do you know any Apostolic people in the target city? Yes ____No _____
20. Have you made any contacts with these people? Yes ____ No _____
21. Are any of these people members of a United Pentecostal Church? Yes ____ No _____
22. Are any of these people members of another Apostolic Church? Yes ____ No _____
23. Would you accept members of another Apostolic Church into your new work as members without working with the pastor? Yes ____ No _____
24. Is there any (non-UPCI) Apostolic Church located within the target city?Yes ____ No _____
25. How does your family feel about this new work? ______
______
______
Personal Info / More History:
26. What is your state of health? Good ______Fair ______Poor ______
Details (if needed):______
27. What is your spouse’s state of health? Good ______Fair ______Poor ______
Details (if needed):______
28. How many souls have you won outside the pulpit during the past two years? ______
29. How many Home Bible Studies have you and your spouse taught in the past two years? ______
30. How long do you think that a pastor should stay with a new work before moving to another?______
31. How long do you plan to stay in this city?______
32. Will you cooperate with the District to the best of your ability?Yes ____ No _____
33. Will you give to North American Missions and to Global Missions?Yes ____ No _____
34. What kind of work do you do?______
______
35. How are you going to support your family?______
______
36. Do you have any outstanding bills? Yes ____ No _____ Are your payments current? Yes ____ No _____
38. Approximately how much do you owe? Mortgage_____ Auto_____ Charge Cards_____ Bank Notes_____ Store Accounts_____ Other_____
______
39. Are you and your spouse good money managers? Me: Yes ____ No _____My Spouse: Yes ____ No _____
40. Do you hereby authorize the District to run a Credit Reference Check on your name?Yes ____ No _____
41. My Social Security Number:______My Spouse’s Social Security #: ______
42. What do you preach to be essentials as the Bible requirements for salvation? ______
______
______
______
43. What is your approach in presenting holiness to new converts? ______
______
______
44. Do you have a television set in your home?Yes ____ No _____
For the purposes of this application, “television set” is defined as “The appliance sold universally as a television that is connected to a device that enables the reception of programming, such as cable, satellite, or an antenna.”
44. If called upon to do so would you fill a District office?Yes ____ No _____
45. Is your Pastor supporting your move? Yes ____ No _____ Will he give you a letter of recommendation? Yes ____ No _____
Please have your Pastor send a letter of recommendation to the District Superintendent and the District NAM Director.
45. Will your District Superintendent give you a letter of recommendation?Yes ____ No _____
Please have your District Superintendent send a letter of recommendation to the District Superintendent and the District NAM Director.
46. Are you applying for N.A. Missionary status, or simply for permission to start a new church, or both? ______
I have answered the above questions to the best of my knowledge and understanding. If I am approved as a North American Missionary, I pledge to cooperate with the WV Department of North American Missions in every way possible, as well as with the WV District.
Date: ______Signature of Applicant: ______
Notes to the Applicant:
Please attach a photo of you and your family when submitting this application,
Also, please include a personal note or letter covering anything you feel is important to express your burden more fully.
References:
Please give the names, contact info, and complete mailing addresses with zip codes, of not less than four persons who are qualified to give further information about you:
1. Name: ______Phone(s): ______Email: ______
Mailing Address:______City: ______State: ____ Zip: ______
2. Name: ______Phone(s): ______Email: ______
Mailing Address:______City: ______State: ____ Zip: ______
3. Name: ______Phone(s): ______Email: ______
Mailing Address:______City: ______State: ____ Zip: ______
4. Name: ______Phone(s): ______Email: ______
Mailing Address:______City: ______State: ____ Zip: ______
Return completed application with any other pertinent info to: NAM-WV Missions, 115 W. Brighton Ave. Moorefield, WV. 26836
Note: The following is for board use only:
The foregoing application has been reviewed by the WV Dept. of North American Missions on ______(date)
….and [ ] does [ ] does not have its recommendation for the following reasons:
______
______
______
______
______
______
Signature of WV NAM Director: ______
The foregoing application wasreviewed by the West Virginia District Board on ______(date)
….and was [ ] approved [ ] disapproved
….If approved, we recommend that the applicant be granted [ ] full [ ] partial benefits as a North American Missionary in the District of West Virginia (please explain):
District Superintendent______
______
District Secretary______
______
Presbyter ______
______
Presbyter ______
______
Presbyter ______
______
Presbyter ______
______
Presbyter ______
______
Presbyter ______
______
After application has been approved, please return to the District Director of North American Missions to be placed in the applicant’s file.