Updated Endorsement Request Form Updated Endorsement Request Form Please check one of following: * Federal Endorsement Institutional Endorsement Last Name: * First Name: * Middle Name: * Address: * City: * State: * Zip Code: * Country: * Phone Number: * Email Address: * If Federal Endorsement, please complete the following questions: Date of Birth: (MM/DD/YYYY) Last four digits of your SSN: Date of Ordination: (MM/DD/YYYY) Ordination Region: Number of years of professional ministry experience prospect has completed: Number of months of prior active military service prospect has completed: Officer: Enlisted: Application is for (choose one): Reserve (non active duty) National Guard Initial active duty (3 years) Extended active duty (indefinite) Regular Commissioned Officer Reserve (AGR) Recruiting officer’s e-mail address: If Institutional Endorsement, please complete the following questions: Date & Location (City & State) of Ordination: Name & Address of Institution: Employee Status (Full or Part Time): If this is a part time position are you employed elsewhere? If so, please include name, city and state of employment. Institutions e-mail address: This MUST be supervisor or information on who should receive endorsement, NOT chaplain) Position applying for: Please type the words below and click submit. If you are human, leave this field blank.
