Licensed Lay Worship Leaders Application for Initial LicensingOct 29, 2019 | Region 15 FormsName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Primary Phone*Secondary PhoneHome Community of Faith*Home Community of Faith Address* City State / Province / Region Brief faith statement (500-700 words)*Specifically, please address these questions: "Where do you feel you have grown?" and "Where do you feel you need to develop more?"Confirmation of completion of mandatory Boundaries training (or confirmation of being placed 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 mandatory Racial Justice training (or confirmation of being placed 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")Proof of Police Records Check, including vulnerable sector.If you are unable to upload a file please mail to Regional Council 15 LLWL, 21 Wright Street, Sackville, NB E4L 4P8.Max. file size: 64 MB.What training have you completed: (Atlantic Residential, United in Learning online, previous biblical/Theological training)*Date of completion of training planned (above)* MM slash DD slash YYYY Reference letter from an instructor as to suitability for leadership.If you are unable to upload a file please mail to Regional Council 15 LLWL, 21 Wright Street, Sackville, NB E4L 4P8.Max. file size: 64 MB.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* MM slash DD slash YYYY Action of the Community of FaithPlease upload a document that includes the date and motion of support/recommendation from the governing body of your home community of faith; 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 to Regional Council 15 LLWL, 21 Wright Street, Sackville, NB E4L 4P8.Max. file size: 64 MB.Office Use:Action of Regional Council 15 Licensing Committee:We Approve: Yes / NoDate: ______________Signature: _________________________Share this:Tweet
