Christian Chaplains Corps of America

-- Membership Application --

To apply for membership in the Christian Chaplains Corps of America,
one must be a CHRISTIAN, and a CITIZEN (or Legal Resident) of the United States of America,
or of a U.S. Territory (U.S.Virgin Islands, Guam, Puerto Rico, or American Samoa).

Fill in the form below, click on the "Submit" button at the bottom, and soon you will be contacted with additional information.
(CCCA below refers to the Christian Chaplains Corps of America)

Application for CCCA membership

Your FULL Legal Name: (First, Middle, Last)
Your Email Address
Postal Mailing Address
County (not country) you live in:
Daytime Phone:
Evening Phone:
Cell Phone:
Website, if any:
Date of Birth:
Gender (M/F):
Marital Status:
What is your Occupation?
What are your Hobbies?
What is your highest education completed (high
school, college, etc.)?
What degree(s) do you hold, if any?
Are You a Citizen of the United States?
Have you ever been arrested or had criminal
charges filed against you? (If Yes, please

Are You Currently Active Duty Military?
If so, Branch
Are You a Veteran of US Military Service?
If so, Veterans Branch:
Veterans Rank
Type Discharge
Dates of Military Service:
If you are currently Active Military, or a
Veteran, what is/was your Military Specialty
(title, not MOS)?
Are you currently active with any other
Chaplains organization?
If so, please list them
List any previous Chaplains organizations you
have been involved with

Do you understand that the CCCA is a
Non-Sectarian, Non-Denominational Christian
Have you and do you profess Jesus Christ as your
personal Lord and Savior?
What is your Christian affiliation or
Are you currently in the Ministry?
Are you, or have you been, Ordained?
Ordained by (Church or Organization):
How many years have you been ordained/active in
If you have a Yahoo Profile ID, enter your Yahoo
ID here:
List a personal reference #1 (Name, Address,
Email address, Phone number)

List a personal reference #2 (Name, Address,
Email address, Phone number)

List a personal reference #3 (Name, Address,
Email address, Phone number)

Comments: including your skills, training,
ministerial experience, military experience,

Applicant referred by:
Do you affirm that the information provided
above is truthful and accurate?

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