Clergy Registration Data Commission Application
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All Information is Confidential & Safe. Information obtain here will be used for Licensure purpose only.
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| Name
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| Prefix
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| First
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| Last
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| Suffix
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| MI
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| Middle
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| Birthdate
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| Home Address
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| Street Address
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| Address Line 2
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| City
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| State / Province / Region
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| Postal / Zip Code
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| Country
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| Phone Number
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| Name of your church
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Your Church 'MUST' be Incorporated. The church has to be in GOOD STANDING with the Secretary of State. (see our website for details on Incorporation)
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| Church Address
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| Street Address
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| Address Line 2
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| City
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| State / Province / Region
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| Postal / Zip Code
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| Country
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| Church Phone Number
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| Your Title
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| Name of Apostle, Bishop, Pastor, or Overseer, ect.
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| Any current criminal involvement as it relates to the Ministry?
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Yes No
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| Name of Theology or Seminar School(s) Attended. (optional)
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| Date of Certificate or Degree (optional)
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MM/DD/YYYY
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| May We Contact Your Pastor?
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Yes No
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| Email
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I certify that the information contained in this application is true. I understand that falsifying any information on this application may cause forfeit of Licensure, and immediately termination out of CRDC database. When Licensure expires, my name will appear as "Inactive" in CRDC database. There's No Membership Refund.
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| Do you agree with the terms and conditions?
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Yes, I agree.
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Consent Form
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| Do you give consent to Clergy Registration Data Commission to release information concerning your license as an Ordained Clergy on our web-site.
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Yes, I give consent No, APPLICATION CANNOT BE COMPLETED please click yes to complete the application, otherwise STOP here.
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| Please select the information to be released on Clergy Registration Data Commission website.
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Educational Level Your Title Date of Ordination Proven Ministry Criminal Involvement (e.g. theft, fraud, rape, ect). Name of Current Ministry and Overseer Previous Ministry(ies) Attended Good-Standing with Ministry Not in Good-Standing with Current Ministry Date License was Issued (from CRDC) Theology or Seminar School(s) Attended (Copy of Degree or Certificate on file)
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| Initial
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| Today's Date
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| Upload Photo for I.D. (Head Shots Only)
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ATTENTION: Please upload a clear "Head-Shot" that is free of all objects in the face including hands, light, hair, clothing, etc. Any photos uploaded with objects in face will cause a delay in Licensure process.
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Image Verification
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EMF Web Form
EMF Web Form