Grace International - Church Planter Application

Please complete all fields below:

First Name:

Middle Name:

Last Name:

Social Security Number:

Date of Birth:

Gender:

Male Female

Home Phone:

Work Phone:

E-Mail Address:

Home Address:

City:

Zip:

Mailing Address:

City:

Zip:

Is this your legal residence?

Yes

Marital Status:

*Provide date of divorce/s,
remarriage/s along with the
circumstances and date of salvation:

Language:

Ethnicity:

Are you currently licensed through Grace International?

Yes

If yes, type of license:

Recognitions License

General

Ordained

Date license received:

Grace International District:

Are you a U.S. Citizen?

Yes

If not, do you have legal residency?

Yes

INS Status

If no, are you able to
legally work in the U.S.?

Yes

If you do not have legal residency,
please explain your status with
U.S. Immigration: