Board Member Application

1Personal

2Survey

3General

4Background

5Agreements

Today's Date(Required)

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Best Phone(Required)

Other Phone

Email(Required)

Date of Birth(Required)

Marital Status(Required)

Educational Background(Required)

Employment Status(Required)

Industry(Required)

Languages spoken other than English

Do you consider yourself a Christian?(Required)

Yes

What is a Christian?(Required)

How long have you been a Christian?(Required)

Give a brief statement about how you came to know Christ as your personal Savior and Lord.(Required)

How has your life changed since your personal relationship with Jesus Christ began?(Required)

Please provide the following information about your church:

Church Name(Required)

Church Phone(Required)

Church Address(Required)

Street Address Address Line 2 City State ZIP Code

Senior Pastor's Name(Required)

First Last

Denominational ties, if any:

How long have you been involved in your church?(Required)

Are you currently involved in a Bible study?(Required)

Yes

If yes, how long?(Required)

Describe positions you have held or services performed with the church.(Required)

Please list the names and addresses of three people, other than your pastor, whom we may contact for references for becoming a board member of the Pregnancy Help Center of Chesterfield.(Required)

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Name

Phone

Address

Code of Conduct

“…set an example for believers (and unbelievers) in speech, in life, in love, in faith, and in purity.” (I Timothy 4:12b) “Whatever happens, conduct yourselves in a manner worthy of the gospel of Christ.” Phil 1:27

We are conscious of the fact that everything we do, directly or indirectly, has the potential to reflect upon PHCC as a whole.
We conduct ourselves at all times with openness, forthrightness, and honesty in dealing with people and organizations, both internally and externally.
We hold ourselves to the highest possible standard of conduct, always striving to avoid even the appearance of impropriety.
All of our communications are truthful, honest, and accurately describe the services we offer.
We operate in accordance with all applicable laws.
We respect confidentiality and only disclose information as required by law or as otherwise authorized by the client/patient.
We treat others with kindness, compassion and in a caring and courteous manner.
We believe in the sanctity of life from the moment of conception to natural death.
We oppose abortion, except to save the life of the mother.
We oppose all forms of abortifacients.
We give accurate information about pregnancy, fetal development, lifestyle issues, and related concerns.
We do not offer, recommend or refer for abortions or abortifacients, but we are committed to offering accurate information about abortion procedures, risks, and abortifacients.
We believe the Bible is the authoritative Word of God and provides guidance for our lives.
We believe in chastity outside of marriage and fidelity within. We believe in the sanctity of marriage between one man and one woman as taught in the Bible. Therefore, all staff and volunteers commit to a lifestyle of sexual purity, and will refrain from engaging in any sexual relationships outside the bonds of Christian marriage.
All Board members, staff, volunteers and other representatives of PRC/PMC shall agree with PHCC’s Statement of Faith, profess Jesus Christ as Lord and Savior, hold a solid prolife position on abortion, and live a lifestyle consistent with biblical values.
All “conflict of interest” relationships will be avoided with Board members, staff, suppliers, those we serve, and other organizations with whom we deal, unless disclosed and approved.
No one will accept gifts or favors which might influence the performance of their responsibilities.

I agree to uphold these values and live a biblical lifestyle.

Statement of Faith

There is one true God of the Old and New Testaments.
All the Scriptures of the Old and New Testaments are inspired, and, if one believes and obeys Jesus Christ, such faith and obedience will bring the remission of sins and eternal redemption hereafter.
Jesus is the Christ, the Son of God, born of the Virgin Mary, without the interposition of man, and He is in the all-inclusive and all-exclusive sense, our Savior, Prophet, Priest, and King.
Jesus died on the cross for the whole human race and for all ages, and His blood cleanses from all sins, on the conditions laid down in the New Testament.
Jesus was buried in the grave, and He came from the grave alive in the body in which He was buried, triumphant over death and the grave.
Jesus gave the Great Commission to the Apostles (Matthew 28:18-20; Mark 16:14-16; Luke 23:45-47; John 20:22-23; Acts 1:8) to embrace all nations and all ages to the end of time.
Jesus Christ sent the Holy Spirit down from Heaven to the Apostles through whom the Gospel was unfolded, and men and women are saved according to the conditions laid down and on record in the book of Acts.
Faith, repentance, confession of faith in Jesus, baptism (immersion) and prayer are for the remission of past sins, and faith, repentance and confession of sins and prayer are for the remission of the erring Christian’s sins (Acts 8:22).
The basis of the Restoration Plea handed down to us by the fathers and the basis of the union of Christendom are found in the New Testament.
Jesus Christ will come at the end of the world and will judge all men and all ages according to that which is written in the Sacred Scriptures.

Are you uncomfortable with any aspect of the center's statement of faith or statement of principle?(Required)

Yes

Please explain:(Required)

In order to submit your application, please confirm that you have read, understand, and agree to the Code of Conduct and Statement of Faith.(Required)

I agree to uphold these values and live a biblical lifestyle.

Signature(Required)

Name

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