EVANGELIST CERTIFICATE PROGRAM
Application for Certificate

Date _______________

Name (Last, First, Middle)

 __________________________________________________________________________

Street Address

 __________________________________________________________________________

City ______________________________ State ____________ ZIP ____________________

Birth Date ________________ Church Membership __________________________________

Indicate the number and name of each Temple School course being used to satisfy the certificate requirements. Make sure that the coursework listed fulfills the requirements of the six core studies and one course from each of the six optional areas. Courses used to complete requirements for other certificate programs may NOT be used for the six optional areas of course work for the Evangelists Certificate.

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

5. ________________________________________________________________________

6. ________________________________________________________________________

7. ________________________________________________________________________

8. ________________________________________________________________________

9. ________________________________________________________________________

10.________________________________________________________________________

11.________________________________________________________________________

12.________________________________________________________________________

Complete and mail to Office of the Presiding Evangelist, 1001 W. Walnut,
Independence, MO 64050-3562; or fax to 816/521-3096