Church Planting Interest Form For anyone interested in being a Dakota Baptist Convention Church Planter or a Church Planting Team Member Step 1 of 3 33% Date* Personal BackgroundFull Name*As on your Social Security Card First Middle Last Home Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Home PhoneCell Phone*Email Address* Birthday* Currently Employed By*Job Title*Marital Status:*SingleMarriedDivorcedWidowedName of Spouse* First Last Are you a U.S. Citizen?*YesNoIf not born in the U.S., please indicate your country of origin.*United StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweIf naturalized, please provide the following:* Date Location If not a U.S. citizen, what is your immigration status?*What type of VISA do you have?*What was your date of entry in the U.S.?* What languages do you use conversationally?* Do you have a desire to plant a church in a particular city or geographical area in South Dakota or North Dakota, and / or with a particular focus or language group?*Rather than being the lead church planter, do you desire to be a church planting team member? (If so, please also share your skills you would bring to the church planting team.)*Are you in agreement with the Baptist Faith and Message 2000 in its entirety?*YesNoPlease share your call to church planting and any church planting experience you have had.*I would like to receive a copy of this report. Send me confirmation. Spiritual BackgroundAge and place of your conversion:* Age Place Have you experience believer's baptism since the time of your conversion?*YesNoAge at which you were baptized?*Name, location, and affiliation of the church in which you were baptized:*Year in which you first affiliated with a Southern Baptist Church:*Name, location, and affiliation of the church of which you are now a member?*Length of time you have been a member of your current church?*Have you been ordained by a local church to the Gospel Ministry?*YesNoIf yes, to the above, please provide the name, location, and affiliation of the church in which you were ordained:*Year in which you were ordained?*Have you ever attended a bible college or seminary?*YesNoIf yes, please provide the name of the school and years attended, any diploma or degree earned:* Please Answer the Following QuestionsDo you practice glossolalia (speaking in tongues) in public or in private?*YesNoIs there anything in your lifestyle that could be of embarrassment to the Dakota Baptist Convention?*YesNoHave you been divorced?*YesNoHas your spouse been divorced?*YesNoDo you consume alcoholic beverages?*YesNoHave you used or do you now use illegal drugs?*YesNoHave you been arrested or indicted for a crime or sexual offense?*YesNoIf you answered, 'Yes,' to any of the above questions, please provide a brief explanation here:CAPTCHA