Vita Form

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This is a recommendation for the position of:
Full Name:
Address:
City, State, Zip:
Work Phone:
Home Phone:
Email Address:
Congregation:
Occupation:
Education:
Certifications, Ordination and/or Licenses:
This person has expertise in (check as many boxes as apply):
Additional areas (check as many boxes as apply):
If Other, Explain:
In what capacity could this person serve? Please note a position or an area:
Age:
Gender:
Additional:
Congregation Involvement:
Mission Area (Synod)/Churchwide Involvement:
Community Involvement:
Name of person completing and offering this referral:
Address:
City, State, Zip:
Work Phone:
Home Phone:
Email Address:
Northern Texas - Northern Louisiana Mission Area, ELCA
1230 River Bend #105 • Dallas, Texas, 75247
MissionOffice@ntnl.org • 214.637.NTNL (6865) • 214.637.4805 (Fax)
Copyright 2012

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