Texas Southeast First Ecclesiastical Jurisdiction

TEXAS SOUTHEAST FIRST ECCLESIASTICAL JURISDICTION

AUTHORIZATION & RELEASE OF INFORMATION

I, ______,of ______

Have filed an application for credentials with the Texas Southeast First Ecclesiastical Jurisdiction Credentialing Board of the Church of God In Christ, Inc. and consented to have an investigation made as to the conduct of my personal life, moral character, and professional reputation in regards to my fitness for ministry or to be a missionary.

I authorize and request any persons, company, corporation, governmental agency, association, church or institution having power of control of any documents, records or any other information pertaining to me to furnish the requested information to the Texas Southeast First Ecclesiastical Jurisdiction Credentialing Board. The requested information may include charges or complaints filed against me, formal or informal, pending or closed. I give my permission to the above named Board or any of its representatives to inspect and make copies of documents, records and other information. I waive any or all rights I may have to inspect or review any information provided to this Board or its representatives by any person or organization.

I relinquish the Texas Southeast Ecclesiastical Jurisdiction Credentialing Board of the Church of God in Christ, Inc.; and its representatives and any person furnishing information from any and all liabilities that may surface as a result of the release of information furnished to the Texas Southeast First Ecclesiastical Jurisdiction Credentialing Board made on my behalf. The Church of God in Christ, Inc. is not required to confirm any information received during the pursuit of its release of information. The Church cannot be held liable for responding on the basis of any information provided which may have been untrue or incomplete.

I have read and signed the Authorization and Release of Information and agreed to it.

Candidate Signature ______

This document must be notarized or the complete package will be deemed incomplete.

STATE OF ______

COUNTY OF ______

Subscribed and affirmed before me this ______day of ______, 20 ______

Notary Public ______

Place Notary Seal here.