Military Chaplaincy Report Form

Please complete the following form. When completed please click "Submit Form" You should receive a notice confirming the submission of your information.

Military Report Form

This form is for active-duty military chaplains and reserve chaplains.
Active-duty chaplains are required to submit this report quarterly - (deadlines are January 31, April 30, July 31 and October 31).
Reserve chaplains are required to submit this report biannually - (deadlines are January 31 and July 31).

Name

First Last

Rank(Required)

Branch of Service

Unit Address(Required)

Year and quarter which the following information applies to:(Required)

Branch of Service(Required)

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Office / Cell Phone

Home Email

Work Email

Pending Changes of Status

Alerted for Transfer: Where and When

Promoted To: (please indicate date of promotion)

If you are leaving Active Duty when will that take place:

Is there any other changes to ministry or status that we should be make aware of? When will that take place?

Ministry Report

My Greatest Blessing This Quarter Was:

Please Pray For:

Worship Services

Bible Studies

Other Small Groups

Crisis/Suicide Interventions

Pastoral Activities: (Please quantify the following activities)

First Time Decisions

Rededication's

Baptisms