FRCA Membership Application

$55 Application Fee — Paid Securely Through Stripe
Your membership application is not submitted for administrative review until the $55 application fee is successfully paid. After completing this form, you will be redirected to Stripe Checkout.
Other membership, screening, training, or credentialing fees may apply separately. Payment of the application fee does not guarantee membership or chaplain credentialing.

1. Applicant Information

First Name *

Last Name *

Preferred Name

Email *

Phone

Date of Birth

Address

City

State

ZIP

Applicant Photo

Emergency Contact

Emergency Phone

2. Ministry & Chaplaincy Background

Church / Ministry Affiliation

Pastor / Ministry Leader

Years in Ministry

Ordination / Licensing Status

Previous Chaplaincy Experience

Current Ministry Responsibilities

4. Training & Qualifications

Education / Chaplaincy TrainingCertifications

5. References

Reference 1 — Pastoral / Ministry Preferred

Name

Church / Organization

Relationship

Phone

Reference 2

Name

Church / Organization

Relationship

Phone

6. Agreements & Certification

FRCA may require additional screening, documentation, training, fees, and background-check authorization before membership or credentialing is granted.

I agree to comply with FRCA background screening requirements.
I have read and can serve in accordance with the FRCA Statement of Faith.
I agree to comply with the FRCA Code of Ethics, confidentiality requirements, professional boundaries, and conduct standards.
I certify that the information provided is true and complete to the best of my knowledge, and I understand that submission does not guarantee membership or credentialing.

Electronic Signature (full legal name) *

Date

1. Applicant Information

2. Ministry & Chaplaincy Background

3. Chaplaincy Interests

4. Training & Qualifications

5. References

Reference 1 — Pastoral / Ministry Preferred

Reference 2

6. Agreements & Certification