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Adult Jail Chaplaincy Team Report Form

What is your name? *
First Name
Last Name
What is the month you are reporting for? *
What year is this report for? *
What are the total hours spent in jail chaplaincy ministry this month?*
Please list the names (Last, First) and JMS/inmate numbers of the inmates and residents you visited this month and that date of your visit/contact.
Did you respond for a specific crisis situation (e.g. death notification, grief intervention etc.)
How has God used you in this ministry?
What is your email address?*
Is there anything else you would like to share with us (i.e., contact information update, barriers to ministry, or suggestions)?
What is your name?*