Discipleship Certification Application

For which certification are you applying?

ChildhoodYouth

Attendee Information

First Name

Last Name

Phone

Preferred Name

Gender

Male

Female

Your Mailing Address

City

State

Zip code

Church Information

Please select the city first to aid in finding the correct church.

Church City

Church Name

My church is not listed.

Church Name

Church City

Address

City

State

Zip code

Title or Role at your church

How long have you served in this or a similar ministry position
in any church?

Years

Months

What training have you previously received for this role?

Length of time string

City ID	Church ID
Today	Event ID
Participant type	Registrant type

Acknowledgement

I acknowledge that I am expected to attend all Certification cohort meetings, Conclave NextGen, and complete all assignments. Any absences will be handled on a case by case basis. For required dates and assignments, please visit txb.org/certification.

I have read and understand the above acknowledgement:

Yes

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