This form must be fully completed by the last Friday in March. This form will be sent to your State/Regional Office and a copy will be sent to your email.I am a …MIP CandidateMIP Candidate Spouse (Seeking credentials)MIP Candidate Spouse (Not seeking credentials)NameEmail Date MM slash DD slash YYYY Ministerial File#Supervising PastorSupervising ChurchCheck the area of ministry in which you desire to serve:(Required) Pastor Assistant Pastor Christian Education Pastor Music Pastor Youth Pastor Children’s Pastor Missionary Evangelist Chaplain Other Other Describe the supervised practicum:What were the benefits for the supervised practicum?Identify items learned in …A Journey Through the New TestamentLeading With IntegrityDid you have weekly meetings with your supervising pastor? Yes No If yes, select the appropriate descriptions of the meetings? Profitable Well-planned Weak Unorganized If not, explain:Did the supervising pastor give you a monthly ministry assignment sheet with assignments? Yes No Did you attend Seminar 6 in March? Yes No How would you rate the seminar? (1-10, with 10 being the highest) 1 2 3 4 5 6 7 8 9 10 What were the strengths about the seminar?What were the weaknesses about the seminar?Identify the topics and assignments you completed this month.Teaching TopicsConducting hospital ministry Yes No Conducting special events; baby dedications and church dedications. Yes No Counseling Yes No Ministering in a crisis situation. Yes No Examples of Coordinating AssignmentsVisit people in a hospital and consult with a hospital or hospice chaplain about ministering to those with a terminal illness. Yes No Plan a baby dedication service and a church dedication service. Yes No Identify principles for counseling and participate in a role play counseling session. Yes No Discuss how to minister in a crisis situation with a police or emergency chaplain and participate in an emergency situation if possible. Yes No Other TopicsOther assignmentsName of State/Regional Office(Required)— Select a State/Region —AlabamaAlaskaArizonaArkansasBahamas-Turks IslandCalifornia/NevadaCanada (Ontario)Canada (Quebec/Maritimes)Canada (Western)DelmarvaEast Central Hispanic RegionFlorida (Cocoa)Florida (Tampa)Georgia (North)Georgia (South)Great Lakes RegionGrenadaGulf Rio Grande Hispanic RegionHawaiiHeartlands RegionIllinoisIndianaKentuckyLouisianaMichiganMid-Atlantic Hispanic RegionMidlands RegionMinistry To Military (MTTM)MinnesotaMississippiMissouriNew England (Hispanic)New England (Northern)New England (Southern)New JerseyNew MexicoNew YorkNorth Carolina (Eastern)North Carolina (Western)North Central Hispanic RegionNorth Central RegionNortheastern Hispanic RegionNorthwestern Hispanic RegionOhioPacific Northwest RegionPennsylvaniaRocky Mountain RegionRomanian TerritorySouth CarolinaSouth Central Hispanic RegionSoutheastern Hispanic RegionSouthwestern Hispanic RegionTennesseeTexasVirginiaWest VirginiaConfirm(Required) I have completed this form to the best of my ability. PhoneThis field is for validation purposes and should be left unchanged.