Community Service Report Form

CSC REPORT

Community Service Chaplain Report

Name:

Email:

This Report is for:

Has your contact information changed since your last report?

Yes

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If yes, please update below:

Primary Email:

Phone:

Street:

City:

State:

Zip Code:

Contribution to COG Chaplains Commission:

Contribution Submitted by:

Special Needs/Prayer Requests:

Awards/Recognition/Promotion:

Significant Activities:

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Thank you for completing your Report. Click the “Submit” button below to send your Report to the Chaplains Commission.

Church of God Chaplains Commission

900 Walker Street NE

Cleveland, TN 37311

Fax:(423) 478-7954

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