Address

Name of Church you Attend:


Pastor:

Give Your Reasons for Wanting To Become a PPM Volunteer:

Check area(s) of PPM Ministries in which you are interested:

Jail / Prison Teaching:

Men
Women
 In-prison  Adult Men  Adult Women 
Juvenile Detention Teaching Youth*
Discipleship/Life Skills Seminars
General Bible Study
Wherever Needed (Office, Phone, Maintenance, etc.)
Other:

* To work with youth, please note that your signature on this form authorizes PPM to request references, employment history and run a background check.

Have you been charged / convicted of any crime, any sex-related or child abuse-related offense?   Yes No
If YES, when?

For What Offense?

Were You Incarcerated? Yes No     No  Yes
Are You Currently On Parole / Probation? Yes No
 

I am not aware of anything that would make me ineligible to serve with PPM. I have a sense of calling and purpose to minister to incarcerated persons. I am willing to abide by PPM’s training and philosophy and to cooperate with all rules imposed by the Departments of Corrections governing the institutions in which PPM serves.