Physical Address

Mailing Address   

City   State   Zip

SSN (xxx-xx-xxxx) (for background & credit check)

Home Phone (with area code)

 Work Phone (with area code)

Cell Phone (with area code)   

E-mail address   

Sponsor Church      City 

Association and/or Network

1. Have you or your spouse ever been divorced? Yes No
2. Are you currently with, or planning to affiliate with, a church planting network? Yes No
3. Are you currently a member of a church affiliated with the Southern Baptist Convention? Yes No
4. Are you already involved in planting? Yes No

If the answer is "yes" to #1, 2 or 4, please explain below.
If the answer is "no" to question #3, please explain below.

During the application process and at any time during the tenure of my voluntary service or relationship with Blue River-Kansas City Baptist Association, I hereby authorize the BR-KC or it’s authorized assigns to procure a background check which I understand may include information regarding my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living.

This report may be compiled with information from credit bureaus, courts record repositories, departments of motor vehicles, past or present employers and educational institutions, governmental occupational licensing or registration entities, business or personal references, and any other source required to verify information that I have voluntarily supplied.

I understand that I may request a complete and accurate disclosure of the nature and scope of the background verification; to the extent such investigation includes information bearing on my character, general reputation, personal characteristics or mode of living.

Type your full name in the box below if you consent to a background check.

Full Legal Name

Rate how true this is of you by selecting a number, 1 – 5. 
(1 = very little     5 = very much)

1. I have started several projects or ministries from scratch.
2. I require minimal direction and supervision in getting something started.
3. I have been able to gather a group of people to help me start a new project.
4. I am always coming up with new ideas for more fruitful ministry endeavors.
5. I can easily recruit, develop, and delegate tasks to people.
6. I have easily and naturally shared the gospel with several people recently outside of a church event or setting.
7. My wife is on board with my calling to plant a church.
8. I have built many deep and long lasting relationships with people.
9. There are no major health, financial, or family obstacles that could keep me from planting.
10. I am willing to be a bivocational planter or receive a smaller salary than I make now.

Enter your total here.   Enter your average here.

Please provide brief answers to the following:

How has your calling to plant been recently affirmed?

Describe several projects or ministries you have started from scratch.

Describe any experience and/or exposure you have had to church planting.

What do you understand to be your spiritual giftedness, and how has that been made known?

How have you seen God use your gift in ministry?

Give examples of a few people with whom you have shared the gospel during the last three months outside of a church event or setting.

Describe the people or community you are interested in reaching.

What have you done to research and understand this people or community? What kind of relationships have you already built?

Describe your readiness to plant. What timeline are you anticipating?

If you were not able to plant in partnership with BR-KC, what would you do?

After you have reviewed and are satisfied with all of your answers, click the submit button below.