Safe Sanctuaries Trainer Application Step 1 of 2 50% Your InformationLegal Name(Required) Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Middle Last Suffix Status(Required) Clergy Lay Date of Birth(Required) MM slash DD slash YYYY Gender(Required) Female Male Application InformationType of Certification(Required) District Trainer Local Church Trainer District and Church(Required) DistrictCheahaCentralMountain LakesSouth CentralNortheastSoutheastSouthwestNorthwest Church If you are not sure of your district, click here to look it up.Contact InformationEmail(Required) Enter Email Confirm Email Primary Phone(Required)Primary Phone Type(Required) Cell Home Office Other Alternate PhoneAlternate Phone Type Cell Home Office Other Mailing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Physical Address(Required) Same as mailing address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your physical address is only used by your district office to connect churches who request trainings with nearby trainers.Additional InformationAdditional InformationIf there is any additional information you believe we should know about your skills and background, you may include it here. AgreementsApplicant Statement and Consent(Required) I agree to the statement and consent.I certify that all information submitted by me on this application is true and complete. I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and active volunteer status may be terminated at any time. In consideration of my volunteer application, I agree to adhere to the Safe Sanctuaries policies of The North Alabama Conference, and I agree that my volunteer status can be terminated, with or without cause, and with or without notice, at any time by the North Alabama Conference or my District Superintendent.EmailThis field is for validation purposes and should be left unchanged.
