Directions:

1. Payment (information at bottom of form)
2. Fill out form
3. Not valid without receipt of payment
4.  After both are received you will hear from a GLR representative

Those desiring to register with the Great Lakes Region as Lay Minister or Lay Ministerial Students, or who are transferring their ministerial credentials into the Great Lakes Region of The Wesleyan Church must pass a Background and Credit Check. Complete the following information authorizing the Great Lakes Region of The Wesleyan Church to conduct a Criminal Background and Credit Check on your behalf. All information will remain confidential and will only be used by officials of the Region and General Church who are authorized to review confidential Ministerial records. You must also pay the enrollment fee before the Background Checks and Ministry Style profile can be completed. Directions for payment are included at the bottom of this form.  Your form is not valid without payment being received. All items marked with an * are required. You may submit this form by clicking the "submit" button when completed.

If you would prefer not to submit this information via the internet, you may complete the form and prior to submitting it, save it as a pdf to your computer. After the document is saved, leave the page without clicking the "submit" button. The information may then be printed and faxed or mailed to the Regional Office. Great Lakes Region of The Wesleyan Church, 1200 60th St SE Kentwood, MI 49508 Fax: 616-827-9451

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* 1. Full name

(First, full middle name, Last

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* 2. Street Address

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* 3. City

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* 4. State

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* 5. Zip Code

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* 6. Home Phone

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* 7. Email address

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* 8. Church in Great Lakes Region in which you are a member or attend:

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* 9. Reason for Requesting Background and Credit Check

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* 10. If enrolling as a Lay Minister or Lay Minister student please provide the following information:

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* 11. Social Security Number

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* 12. Date of Birth

Please provide month/date/year, 00-00-0000

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* 13. Driver's License Number

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* 14. State issuing License:

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* 15. Alias

If you are known by another name or alias, please provide that/those names.

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* 16. Information

Please describe any information that may be in your Criminal or Credit Background checks that would be important for the Regional team to know as they review the information.

Permission to Conduct Background Checks

Your personal information as well as the information provided in the reports will be kept confidential. You may receive copies of the information received by requesting this information through the Regional Office. You will be notified of any issues arising from the information received and will have the opportunity to discuss how this may affect your relationship with the Region. Please indicate your approval for conducting the criminal background check and credit check by checking the appropriate box below and typing your name as a form of electronic signature.

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* 17. Granting Permission

I agree to allow the Great Lakes Region of The Wesleyan Church to conduct a criminal background and credit check on my behalf.

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* 18. Electronic signature

In typing my name, I am providing an electronic signature granting approval for the above-mentioned background and credit check.

Payment

The cost of completing a Criminal Background and Credit Check is $50. Payment may be made through Paypal at the Great Lakes Region website at:https://theglr.org/ministerialdevelopment/. Please use the "Application/Registration Fee for background and credit check" option. Important:  Your enrollment form is not valid without payment. Please be sure to select the "Done" link  at the bottom of this page in order to submit your information.

You may also submit the application fee by check or in person at the District Office. Contact Information for the District Office is available at the Regional website.

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