Mother Church Pastor's Name *

First Name

Last Name

Phone *

(###)

###

####

Mother Church Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have you contacted the presbyter of this section?

Yes

No

Local Area Churches

Is there a United Pentecostal Church in this area?

Yes

No

Have you contacted those Pastors?

Yes

No

What is the Pastor's Name?

First Name

Last Name

Relationship

Have you developed a "plan of action" and "local church policy" to govern the relationship between the mother and daughter church (such as financial arrangements, talent, support, membership transfers, ministerial expectations, and procedures for becoming autonomous)?

Yes

No

District Policy

Have you happened to read the district policy regarding Daughter Works?

Yes

No

Who is your presbyter?

First Name

Last Name

Have you contacted your presbyter about this daughter work?

Yes

No

Daughter Work Pastor

Do you have a pastor to oversee this daughter work church?

Yes

No

Sponsoring Pastor Signature *

First Name

Last Name

Today's Date

MM

DD

YYYY