Application for Synodical Placement
Concordia University – Portland
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Name:
LAST
First
Middle
Home Address*:
Address
Home Phone*:
City
Cell Phone*:
State
Zip
Other*:
Email:
Social Security Number:
Date of Birth:
Congregation of Membership:
Name
Name of Spouse/Fiancée:
City
Is s/he a PCW?
Anticipated Date of Graduation:
GPA**:
2.00 – 2.49
Program:
Yes
LCMS District
No
Available for Placement:
2.50 – 2.99
State
3.00 – 3.49
DCE
DCE w/ Minor:
DCE/Lutheran Teacher Candidate (Check level below)
ECE/ELE
ELE/ECE
ELE/ML
January 1
July 1
Other:
3.50 – 4.00
Post-BA DCE Certification
Colloquy
ML/ELE
ML/HS
HS/ML
Endorsement Area(s):
High School(s) Attended:
Name
City
State
Name
City
State
Name
City
State
Degree
Dates of Attendance
Name
City
State
Degree
Dates of Attendance
Name
City
State
Degree
Dates of Attendance
Name
City
State
Degree
Dates of Attendance
Name
City
State
Degree
Dates of Attendance
College(s) Attended:
* Please notify the PCW Director of any changes to your personal contact information so that you may be reached for placement. It is also your responsibility to notify the
Registrar’s Office of any changes to your personal contact information.
** NOTE: A minimum 2.50 GPA is required for graduation from the DCE and Lutheran School Teacher Program, and a 2.75 GPA is required for educational Licensure.
DIRECTOR OF CHRISTIAN EDUCATION (DCE) CANDIDATE EXPERIENCE:
Practicum for “History & Practice of a DCE”:
Site Name
City
State
Supervisor/Mentor
Dates of Attendance
City
State
Supervisor/Mentor
Dates of Attendance
City
State
Supervisor/Mentor
Dates of Attendance
City
State
Cooperating Teacher
Dates of Attendance
City
State
Cooperating Teacher
Dates of Attendance
City
State
Responsibilities
Primary Responsibilities
Field Work in a Lutheran School for CED 344:
Site Name
Primary Responsibilities
Internship Congregation:
Site Name
Primary Areas of Responsibility
LUTHERAN SCHOOL TEACHER CANDIDATE EXPERIENCE:
Field Experience & Practicum:
Site Name
Lessons Taught
Field Experience & Student Teaching:
Site Name
Lessons Taught
PROFESSIONAL EXPERIENCE:
Employer
Supervisor
Employer
Phone Number
City
Supervisor
Employer
Supervisor
Responsibilities
Phone Number
City
Supervisor
Employer
State
Dates of Employment
State
Dates of Employment
Responsibilities
Phone Number
City
State
Phone Number
Dates of Employment
Responsibilities
Dates of Employment
LEADERSHIP SKILLS:
Please read through each category below and indicate those areas in which you have Training (T), Experience (E), or Interest (I) in your ministry.
Age and Need Groups
T
E
I
Childcare/Infant/Toddler/Pre-K
Childcare/School-aged
Pre-School Age 3
Pre-School Age 4
Kindergarten
Grade1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Multi-Grade (Any level)
Multi-Grade Middle School
Higher Education/College
District/Synod
Adults
Seniors/Elderly
Singles
Disabled
Special Education
ESL
Youth Jr. High
Youth Sr. High
Elementary and/or Secondary Subject Areas
Art (General)
Art (Other: ________________________)
Business Education
Computer Education
Economics
English (Composition)
English (Literature)
English (Advanced Placement)
Language Arts (Elementary)
French
German
Latin
Spanish
Other:
ESL
Geography
Government
Health
History (General)
History (Advanced Placement)
Home Economics
Industrial/Technical Education
Mathematics (Basic)
Mathematics (Advanced)
Music (Vocal)
Music (Instrument:
)
Outdoor Education
Physical Education (Elementary)
Physical Education (Secondary)
Political Science
Psychology
Reading
Religion
Science (General)
Science (Subject:
)
Sociology
Social Studies
Speech
Theater
Theology
COACHING
T
E
I
Athletic Director (Elementary)
Athletic Director (Secondary)
Baseball
Basketball
Cheerleading
Cross Country
Football
Golf
Soccer
Softball
Swimming
Tennis
Track & Field
Volleyball
Wrestling
Other:
Special Education
Learning Disabled
Behavior Disordered
Visually Impaired
Hearing Impaired
Physically Disabled
Autistic
Attention Deficit
Talented and Gifted
Extra Curricular Activities and Service
Newspaper
Yearbook
Computer Club
Peer Counseling
Peer Tutoring
Service Clubs
Drama
Student Government
National Honor Society
Forensics Team
Boosters (Athletics)
Boosters (Band)
Special Events Planning
Alumni Events
Career Day
Student Exchange Programs
Faculty In-Service
Faculty Events
Awards Committee
School Calendar
Community Service
Language Clubs
Other:
School and Church Music
Choir (General)
Choir (Children’s)
Choir (Youth)
Choir (Adult)
Instrumental (Accompanist)
Instrumental (Ensemble)
Organist
Pianist
Keyboard
Hand Bells
Guitar
Drums
Wind:
Percussion:
Strings:
Brass:
Vocals
Worship Leadership & Planning
Orchestra/Band
Other:
Church Leadership
T
E
I
Adult Education
Older Adult Programs
Bible Study (Youth)
Bible Study (Adults)
Confirmation
Small Group Ministry
Contemporary Worship
Traditional Worship
Volunteer Coordinator
Community Programming
Church Communication/Public Relations
Church Administration
Evangelism/Outreach
Assimilation
Fundraising
Midweek Bible School
Vacation Bible School
Sunday School
Youth Ministry (Jr. High)
Youth Ministry (Sr. High)
Church Social Activities
Social Ministry
Singles Ministry
Young Adult/College Ministry
Campus Ministry
Urban/Inner-City Ministries
Photography
Video Technology
Sound Technology
Computer Technology
District Board/Committees
Other: _____________________________
Administration
Director of Christian Education
Director of Children’s Ministry
Director of Christian Outreach
Director of Church Music
Director of Worship Arts
Director of Youth Ministry
Director of Adult Ministry
Director of Family Ministry
Director of Singles Ministry
Director of Campus Ministry
Director of Camp/Outdoors Ministry
Director of Early Childhood Program
Principal (Elementary)
Principal (Secondary)
School Counselor
Testing Coordinator
Registrar
Dean of Students
Dean of Chapel
Department Chair
Director of Student Activities
Director of Library Media
Director of Technology Media
Director of Admissions
Other Leadership Skills Not Listed Elsewhere
PERSONAL INTERESTS:
REFERENCES:
Please provide the names of three (3) individuals who can attest to your qualifications for ministry, professional strengths, and Christian character. These references may be
contacted by Calling bodies (churches, schools, etc.). You may attach letters of recommendation to this application; letters will be included with your Placement file.
1.
Name
Phone
Relationship to Candidate
For How Many Years?
Name
Phone
Relationship to Candidate
For How Many Years?
Name
Phone
Relationship to Candidate
For How Many Years?
2.
3.
CONSIDERATIONS AND PREFERENCES FOR PLACEMENT
A Call to ministry is certainly something inspired by God and guided by the Spirit. God’s Call could occur at any time, to any place – thus the Call to ministry! In some cases,
however, certain considerations must be taken into account. Please notify the Synodical Placement Director of those considerations in response to the following prompts.
1. What living or health needs should be considered for placement?
2. What family or personal factors should be considered?
Types of Community:
Rural (Under 10,000)
Town (10,000-25,000)
Small City (25,000-100,000)
Metropolitan (1,000,000++)
Inner City / Urban
NO PREFERENCE
Large City (100,000-1,000,000)
Geographic Preferences:
Please select your preferred regions and number them in order of preference, with 1 being the most-preferred and 6 being the least-preferred. Refer to the map below.
- Northwest and Alaska (Region 1)
- West Coast and Hawaii (Region 2)
- Rocky Mountains (Region 3)
- Midwest (Region 4)
- South (Region 5)
- East Coast (Region 6)
I am interested in International Ministries
NO PREFERENCE
DCE Assignment Preferences:
If you will be licensed to serve as a Director of Christian Education, please indicate any preferred areas below.
Children & Family Ministries
Youth Ministry
Adult Ministries
Camp Ministries
Worship Ministry
Teaching Assignment Preferences:
If you will be licensed to serve as a Lutheran School Teacher with ECE or ELE authorization levels, please indicate any preferences below.
Pre-School
Kindergarten
Primary Grades: 1-3
Intermediate Grades: 4-6
Middle Grades: 7-8
Write a brief paragraph describing your concept of ministry and reasons why you have chosen to be a church work professional:
Please identify and explain five descriptors that characterize you as a person, and explain why you chose each word:
1–
2–
3–
4–
5–
I, the undersigned, do hereby grant permission for the Director of Synodical Placement at Concordia University – Portland, Oregon, to
release any or all information in my placement and/or credential file to Pastors, School/Agency Administrators, and/or Congregational
Boards who request such information.
___________________________________________________________________________
________________________________
Applicant’s Signature
Date
Submit Completed Application To:
Sarah Hames, DCE
2811 NE Holman St.
Portland, OR 97211