Certificate Request Form

In order for certificates to be printed, we need a list of names of those completing the Mobilize program. This form is to be completed and sent to the office of Ministerial Development/School of Ministry at least four weeks before the scheduled presentation date. In order for the certificates to be issued, please ensure that full payment of the account has been made and all the required forms have been sent. See linked checklist.
Proposed Presentation Date
MM
DD
YYYY
Name of Pastor*
Local Church*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number*
Email*
Please type each name just as it is to appear on the certificate.

List of Participants:*

Student's name as it will appear on certificate.	Ministry Completed

To add lines for additional students, click on the plus icon to the right.

Confirmation*
- I certify that the participant(s) listed above has (have) met all the requirements of their chosen Mobilize program.