Licensed Lay Worship Leaders Application for Re-Licensing

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Primary Phone*

Secondary Phone

Home Community of Faith*

Home Community of Faith Address*

City State / Province / Region

Confirmation of Completion of mandatory Boundaries training (or confirmation of being on a waiting list)*

Please enter if this is the date completed or date of joining waiting list. Enter date in MM/DD/YY format. (ie "Completed 12/15/97" or "Joined 12/15/97")

Confirmation of Racial Justice training.*

Please enter if this is the date completed or date of joining waiting list. Enter date in MM/DD/YY format. (ie "Completed 12/15/97" or "Joined 12/15/97")

Police Records Check (PRC)*

Please enter the year you received your PRC (note that PRCs are good for five years).

What continuing training have you completed since you were last licensed?*

Reference letter from a someone who has experienced your worship leadership.

If you are unable to upload a file please mail directly to Brian DeLong, 1245 Kingsley Road, Birdton, NB E3G 6E1.

Max. file size: 64 MB.

I am prepared to travel up to the below number hours to serve as LLWL

I am prepared to travel up to the below number of kms(return) to serve as LLWL

Consent*

I am aware of and have considered the LLWL handbook, 2019, and agree to the process outlined therein including outline of eligible services and limitations to these services, training requirements including the need to have taken the Boundaries Training of The United Church of Canada: *

Date*

Action of the Community of Faith

Please upload a document that the Community of Faith supports your application to be re-licensed as a lay worship leader within Fundy St. Lawrence Dawning Waters Regional Council; signature of representative of Faith Community; and signature of ministry personnel of faith community or pastoral charge supervisor. If you are unable to upload a file please mail directly to Barbara Prowse, 413- 215 Mina Jane Drive, Charlottetown, PEI C1E 3M8.

Max. file size: 64 MB.

Contact Information

Please let us know if you give permission to include your name and contact information on the Regional website.

Yes, I give permission for my information to be shared on the Regional website
No, I do not give permission for my information to be shared on the Regional website

Office Use:

Action of Fundy St. Lawrence Dawning Waters Regional Council Pastoral Relations Committee:

We Approve: Yes / No

Date: ______________

Signature (either the Secretary or Chair of Pastoral Relations Committee): _________________________

Signature of Staff Support to MPE: ____________________

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