I voluntarily and knowingly authorize Chi Alpha Campus Ministries, U.S.A. of the Assemblies of God to contact personal references in determining whether to approve me as a director of a nationally approved Campus Missionary-in-Training program, and I expressly authorize any reference so contacted to respond fully to any and all questions regarding my fitness and competence for a CMIT approval. I agree to abide by the Chi Alpha Campus Ministries, U.S.A.'s decisions and if, approved, to cooperate fully carrying out its policies and programs.

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Signature Certificate

Document name: CMIT Program Application - Personal Authorization

Unique Document ID: aabdbdb1dfa92723ac11850be27c36e3dee8183f

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Timestamp	Audit
November 2, 2017 1:22 pm CDT	CMIT Program Application - Personal Authorization Uploaded by CMIT Program - [email protected] IP 66.119.29.16
December 6, 2017 12:23 pm CDT	Document owner [email protected] has handed over this document to [email protected] 2017-12-06 12:23:44 - 66.119.29.16
November 26, 2018 4:37 pm CDT	Document owner [email protected] has handed over this document to [email protected] 2018-11-26 16:37:08 - 66.119.29.16, 127.0.0.1

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Audit Trail Serial# 8d98eabd4632a1848e66dc3d4274d0b4