5-Year

Connection

This review is conducted every five years as called for by our Credentials Manual (2023 edition)

5-Year Connection Form

Section One: Regional & National Involvement and Personal Growth

Pastor's Name

First Name

Last Name

During the past five (5) years, how have you been active in the ministry of the Church of God (Anderson, IN)? List specific duties.

Which Association events have you attended during the past 5 years? Please list specific events and dates.

What offices or responsibilities in the Association are you currently holding or have held in the past 5 years?

Which Regional or National Church of God activities did you attend in the past 5 years?

What continuing education or professional training have you had in the past 5 years?

What is the best book you have read in the last 5 years?

How would you describe your walk with Jesus now compared with 5 years ago?

What are your personal and professional goals for the next 5 years?

(Retired Pastors Only) What church are you attending and how are you supporting your church?

How do you see the direction of the Church of God? What suggestions do you have?

Are there any areas of disagreement you have with major Church of God theology as you understand it? If so, please explain.

How can we help you?

Do you want to share more with the Ministerial Fellowship Committee, Credentials Committee, and/or District Leadership?

Do you want someone to contact you personally?

Section Two: Background Check Consent

BACKGROUND SEARCH: For the safety of our children and youth, a background search will be completed on all ordained ministers. Your signature below authorizes Church of God Northwest and/or its agents to make an independent investigation of your background, references, character, past employment, education, criminal, or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on this application. I release the Association of the Churches of God in Oregon, Inc. and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims, or lawsuits in regards to the information obtained from any and all of the above referenced sources used.

Full Legal Name (First, Middle, Last)

Maiden name or other names used

Date of Birth

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Work Phone

(###)

###

####

Home Church

Driver's License Number

Driver's License Issued by Which State?

List ALL states in which you have resided

If you've lived in California, please list EVERY California County in which you have lived

If you have never lived in California, please state: Does Not Apply

Have you been convicted of any crimes of abuse to children or youth?

Yes

Signature

I authorize the type-written name below to suffice as my signature. I have read, understood and agree to completely comply at all time with both the Policy for Preventing Abuse of Children and Youth and the Oregon Child Abuse Reporting Law.

Please complete this form within 14 days of receiving it.

Failure to complete the 5-Year Connection may result in removal from the approved list.