PHIPA Application – The Pottershouse Forms

3635 Dan Morton Dr - Dallas, TX USA 75236
Phone: (214) 337-8175 or (214) 333-6459
Email: phipa2@tdjakes.org

Please submit a copy of your Church Mission and Vision Statement. Once the application is reviewed and accepted you will be contacted requesting your first offering / tithes from your monthly income to complete the membership with the PHIPA Alliance.

All payments must be made payable to: PHIPA
Today's Date
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Personal Profile
Name
First Last
Birth Date
Date Format: MM slash DD slash YYYY
Email
Primary Phone Number
Alternate Phone Number
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Are you married?*
- Yes
- No
Spouse Name
First Last
Spouse Email
Spouse DOB
Date Format: MM slash DD slash YYYY
Wedding Anniversary
Date Format: MM slash DD slash YYYY

Church Information
Church Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Church Email
Church Website
Church Phone
Alternate Phone
Church Fax
Pastor Anniversary
Date Format: MM slash DD slash YYYY
Year Church Established
Memberhip Size
Number of Staff and Leadership
Church tax exemption
- Yes
- No
501(c)3 certification
Administrative Assistant Name
Administrative Assistant Email
Administrative Assistant Office Hours
Additional Information
What are your expectations of this Alliance that you want as a Senior Pastor?
Are you a part of another Alliance or an Assembly that would have conflicts with you joining and/or participating with joining this Alliance?
Church Vision and Mission Statement
Church Outreach, Ministries and Auxillaries
How did you hear about PHIPA?
Name
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Personal Profile