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UACCCI Ministries

Independence, Mo

UACCC Ministries & UGSI



Name: ________________________________ Spouse: ___________________

Address:___________________________ City,St, Zip:_____________________

Phone: H _________________________ Cell__________________________

E-Mail Address: __________________________________________________

Are you a Born Again Christian? Y N Date___________________

Are you Active in any Ministry? ______________________________________



Do you have any Legal Issues? Y N “If Y Please explain “


Are you a Good Steward of you Finances, Time, Talents & Gifts? Y N

Do you Agree with the UACCCI

Doctrinal Statement & Code of Ethics (on Website) Y N

Please Print, Sign & Date them & send in with Application.

Do you give us Permission to run a Background Check,

upon submitting Applcation, & that the cost of this has to be sent

with Application? (you can Pay on Website, through PayPal) Y N

Please list 3 Personal/Ministry References that we can Contact......

Name: _____________________________ Phone # _____________________

Name: _____________________________ Phone #_____________________

Name:_____________________________ Phone #_____________________

Are you Applying for UACCCI …......

___Ordination, ____Chaplaincy ______Biblical Counselor

Have you watched the On-Line Vidios & Completed Assignments? Y N

Are you Applying for a Degree through UGCS?

If you need to make payments on Degree Courses, will you sign a

UACCCI/UGSI, Agreement on Payments? Y N

Degree interested in pursuing? ______________________________________.

Signature _____________________________________________



Fill out Application, Copy & Sign Doctrinal Statement & Code of Ethics, &

Ministry Resume -----

Submit Payment & Fee for Background Check $_________ through PayPal

on Payment Link,

Copies of your Certifications &/or Degrees.


Date Recvd. ________________

Was all Paperwork Recv'd & filled out Correctly ? Y N


Was Payment (s) made Y N


Background Check Submitted on: _________________,

Recv'd on: __________________

Reference Checks Completed on ________________

Questions: How long they have known Applicant? Pers/Ministry

Is the Applicant, Honest & Trustworthy?

Is the Applicant active in Community/Ministry?

Any known Personal/Legal Problems?

Has Applicant have Leadership & People Skills?

Any other Info? ( use back of App for Notes)

Was Application?: Approved Rejected Date ___________________

Signature of UACCCI Officer completing this.____________________________