Religious Credentials.pdf

BP-A0777 U.S. DEPARTMENT OF JUSTICE

JUN 10 FEDERAL BUREAU OF PRISONS

CREDENTIALS OF RELIGIOUS VOLUNTEER

1. PERSONAL PROFILE

Name Address

Telephone Religious Affiliation

Civic Affiliations Professional Affiliations

Country of Origin Citizenship

Immigration Number (If Landed Immigrant)

Naturalization Number (If Naturalized Citizen)

Foreign Travel (Countries Visited Last Five Years And Time Frames)

Funding from Foreign Governments

Have you lived in the United States three of the last five years? ____ Yes ____ No

2. VERIFIABLE RELIGIOUS CREDENTIALING AUTHORITY (Religious Certifying Authority, such as Superintendent, President, Religious Superior, Pastor, etc.)

Name Title

Address Telephone

Local Congregation (Name and Address) Length of relationship with religious credentialing authority

3. EDUCATION

College Degree/Date

Seminary/Graduate School Degree/Date

Other Graduate Degree(s) Degree/Date

4. As a religious volunteer, I am aware of and agree to comply with Code of Federal Regulations Rule §548.15, which states, “no one may disparage the religious beliefs of an inmate, nor coerce or harass an inmate to change religious affiliation. Attendance at all religious activities is voluntary and unless otherwise specifically determined by the warden, open to all.” I do not endorse nor will I practice or use language in the institution that will support violence, terrorism, discriminate against other inmates or exclude other inmates from religious services based on race, color, religion, gender, or national origin.

Signature of Volunteer: Date:

PDF Prescribed by P5360 This Form replaces BP-S777.053 dtd AUG 03

The Following Section to be Completed by the Chaplain

Ordination/Equivalent:

Yes: ____ No: ____

Faith Group Date

Comments:

Chaplain’s Signature

Religious Subject Matter Expert (SME)Review (If Needed)

Comments

Religious SME Recommends Volunteer _____ Religious SME does not Recommend Volunteer _____

Date Reviewed: Signature of Religious SME:

PDF Prescribed by P5360 This Form replaces BP-S777.053 dtd AUG 03