Request for Credential Change

Application for change FROM:(Required)

Application for change TO:(Required)

Name

First Last

Permanent Home Address(Required)

Street Address Address Line 2 City Province Postal Code

Phone(Required)

Please provide the number where we can most easily reach you.

Email(Required)

Enter Email Confirm Email

Please provide the email address where we can most easily reach you.

Please explain current activities or other reasons that warrant this change in credential status.(Required)

Are you contributing regularly to the support of Elim Fellowship Canada?(Required)

If NO, explain:(Required)

Your Pastor's Name

Full Name

If your present ministry is under the direct supervision of or related to a pastor, please have them email their recommendation with regard to the above changes to office@elim.ca

Today's Date(Required)

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