» Regional Endorsement Form

This form is to be used by Regional Ministers (and/or designated Area/Associate Regional Ministers) to provide endorsements for, and as requested by, clergy with Standing in their region who are seeking a Clergy Continuing Education Grant from Disciples Home Missions. Clergy who are applying for their own grant should not complete this form. Upon submission, you (the regional minister) will receive a copy of this form via email. Thank you.

Date

Name of Region *

Name of Regional/Area staff Minister who is completing this form *

Regional Staff Person's Email address *

Regional/Area Staff Person's Phone # *

Full name of Clergy Applicant seeking C.E. grant *

Select the Clergy Applicant's CURRENT Ministry Credential: *

Ordained Minister

Commissioned Minister

Other

(If you chose "Other", Please explain as part of your comments in the "Comments..." box at the bottom of this form.)

Is the Clergy Applicant currently in Good Standing within your region? *

Yes

(If you selected "No" for this question, please explain in "Comments..." box below.)

To your knowledge, are there any investigations and/or pending decisions/actions that may affect/change this Clergy Applicant's Standing? *

Yes

(If you selected "Yes," please explain in "Comments..." box below.)

Amount region will invest in Clergy Applicant's C.E. program *

Comments regarding Clergy Applicant's request for funds

(Use this space to make recommendations, share concerns, provide any comments related to minister's credentials that might possibly affect any grant awarding decisions, and/or other information you deem helpful to the DHM Committee responsible for making grant award decisions.)

Name of Region *

Christian Vocation Continuing Education

Contact Information

Warren Lynn

Kelly Harris