CHURCH INFORMATION FORM Church Information Form // GENERAL INFORMATIONLegal Church Name: Current Church Name - if applicable Office Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you have another address where you meet for services? Yes No Meeting Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code When are you services? Church Ofice Phone:General Email: Office Contact: Title: Office Contact Email: Date Church was Founded MM slash DD slash YYYY EIN#: // TAX EXEMPTION INFORMATIONAre you Tax Exempt? Yes No Unsure I would like more information from VCN about this. Are you under the VCN State and Federal Tax Exemption? Yes No Unsure Would you like more information about State and Federal Tax Exemption? Yes No State Tax Exempt# EIN Number: // ETHNIC MINISTRIESDo you have ethnic ministries at your church? Yes No If Yes, please share the ethnic community, language and meeting times. Pastor's Name Pastor's Email // WEBSITE & SOCIAL MEDIAChurch Website: Facebook Instagram You Tube Other Social Media // SENIOR/LEAD PASTOR INFORMATIONName First Last Start Date MM slash DD slash YYYY Pastor's Church Phone Number:Pastor's Mobile Number:Pastor's Email Personal Website (if applicable): College/Jr. College - Location, Degree, Year of Completion Graduate School/Seminary - Location, Degree, Year of completion Certificates - Type, Who gave you the degree? What year? Are you licensed? Yes No In Process Who were you licensed with? When? Where? Are you ordained? Yes No In Process Are you interested in ordination? VCN ordains pastors in partnership with your local church. Who ordained you? When? Where? Are You Married? Yes No Wife's Name Date of Marriage: MM slash DD slash YYYY Wife's Email Wife's Mobile Number:Do you have additional Staff? Yes No Staff Person 1 First Last Position PhoneEmail Staff Member 2 First Last Position PhoneEmail Staff Person 3 First Last Position PhoneEmail Any further commnets before submission? Questions?Contact Sally Hahn
