2021 Chaplaincy Report and Application Survey

For Ordained Ministers with the Chaplain (CHP) designation
NOT serving as Military Chaplain.

1.Personal Contact Information(Required.)

First Name

Last Name

Address

City

State

Zip

Phone

Email Address

2.Local Church Membership(Required.)

3.Agency/Agencies you serve as a chaplain

4.This assignment is:

Full Time (at least 30 hrs/wk and 51% of income)

Part Time

Volunteer

5.Ways in which you have supported your local Church of the Nazarene

"I request the Oklahoma District Board of Ministry to consider me for the Chaplain (CHP) Role Code for the coming year."

6.Signed (your name typed in will be considered as an electronic signature)