This form is intended to keep the Missionary Candidate Office informed annually concerning present and anticipated future activities of accredited candidates with the C&MA. During the year, please keep us current on your address, phone number, and email address. Please complete this form and submit it to the office as soon as you are able to do so. If married, BOTH husband and wife should complete a form; if the spouse is not yet accredited, he/she should also complete a form. An "*" indicates a required field.

Candidate Name*
Current Address*
City*
State*	Not Sure Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code*
Office Phone*
Home Phone*
Cell Phone
Email Address*
Anticipated Changes?
Effective:
Current C&MA district living in?*
Anticipated Status/Assignment for Next 12 Months
1. Further Education
School
Program of Study
Expected Completion Date
Anticipated Degree
Date Started
Current Educational Debt
2. Ministry to Fulfill Home Service Requirements for Career Candidates
Location
Position
District
Date Started
Date of Expected Ordination (for men or consecration for women)
3. Professional Experience for Missionary Associates
Location
Position
Grade Level/Subject Focus (if teaching)
Date Began
Date Ended
Secular Employment
Date Began
Expected Completion Date
Other Plans
Marital Status
Marriage Date
Place
Name of Fiance(e)
Anticipated Wedding Date
His/her Present Activities
If non-candidate, does he/she expect to apply for candidacy?
Family
If any children have been born or adopted following application or last report, please provide details.
Full Name
	Male Female
Date of Birth
Place of Birth
Future Plans Leading to Appointment
Anticipated date for completing overseas requirements
Proposed plans for completing requirements
When is the earliest that you would be ready for overseas service?
Country to which you would like to be appointed?
Are you hoping to be considered for a Spring or year-end appointment?
	Please print a copy of the form for your records before hitting submit.