Certification of Church Membership

To the Student:

Please forward this form to the appropriate church leader for completion.

This form must be completed by your lead pastor or designated church staff member who oversees church membership. Do not complete this form yourself.

If you serve as the pastor, please have another church leader complete the form on your behalf.

To the Pastor* or Designated Church Staff Member:

Each year, we ask our students to verify their current church membership. This form must be completed by the lead pastor or designated church staff member who oversees church membership.

This verification is important because it helps us maintain accurate records and ensures accurate communication with the Southern Baptist Convention (SBC) regarding student membership and funding. All students are required to complete this verification, regardless of their church’s denominational affiliation.

We also ask for information about your church’s state and local affiliations. While this information may not directly affect the student, it provides valuable information about the churches we serve and is very helpful to us.

Thank you for taking the time to complete this verification.

* If the student serves as the pastor, please have another church leader complete the form.

Annual Deadline: December 31

Student Name(Required)

First Last

Student ID Number (if known)(Required)

Full Name of Church(Required)

Physical Address of Church(Required)

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

Church's Phone Number(Required)

What is your position on your church staff?(Required)

Pastor

Alternate Staff Member

Pastor's Name

First Last

Alternate Staff Member - Name

First Last

If someone other than pastor/moderator has completed this form, please give your name and your position at the church.

Alternate Staff Member - Position

Is this church a cooperating member of the Southern Baptist Convention?(Required)

Yes

If not, with what denomination does this church identify?

If yours is a Texas SBC church, with which convention(s) does your congregational associate?(Required)

Baptist General Convention of Texas (BGCT)

Southern Baptists of Texas Convention (SBTC)

Both BGCT & SBTC

N/A

If your church is in another state, please select your state convention

Please tell us if your church is a member of any other local associations/affiliations.

If you have any questions regarding this information or this student’s membership, please contact us at [email protected].

*Students may submit new/updated information at any time during the year. Any changes to denominational affiliation will take effect for the following term, unless received before the close of the enrollment period for the term.

Certification of Church Membership

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