"*" indicates required fields Is this application for a new license or renew a current license?* New license application Renewal license application Name* First Last Email* Home Church/City*ex: St. Martin's, AnytownDo you have the recommendation of your Clergy or Warden in Charge?* Yes No Do you have the recommendation of a Deacon under whom you will function?*(if available) Yes No If so, please enter the name and email address of said DeaconDo you have the recommendation of your Vestry or Bishop's Committee?* Yes No List the date of your last Diversity & Reconciliation Training course*If none, please stop your application and contact Shirley Bolden (shirleybolden727@gmail.com) to sign up your Diversity & Reconciliation Training MM slash DD slash YYYY List the date of your last diocesan criminal background check*If none, please stop your application and visit https://diowestmo.org/admin/background-information-release-form/ to submit your "Criminal and Social Security Trace (Verified Plus)" application MM slash DD slash YYYY List the date you completed the Safe Church, Safe Community training coursework*If none, please stop your application and contact Elaine Gilligan (hr-finasst@diowestmo.org) to request access to the Safe Church, Safe Community online coursework MM slash DD slash YYYY Signature*I pledge to carry out this ministry to the glory of God under the authority of the Bishop of West Missouri, and with the integrity befitting this sacred trust.CAPTCHANameThis field is for validation purposes and should be left unchanged.
