Professional Clergy/Lay Persons Application
Elkhart County Sheriff’s Department
(click the print button in the upper right corner)

All professional clergy and designated laypersons that want special access to the County Jail are required to fill out this form and submit it to the Jail Commander. After receiving the completed application the applicant will be interviewed. The purpose of the interview is to explain procedures and to ensure that all information is complete. If more information is needed the interviewer will request such from the person’s supervisor or the equivalent. At the time of the interview, the interviewer may give provisional approval if the applicant has an immediate need to have access to the Jail. The Jail
Commander will give final approval in all cases.

Name: __________________________________________________________________________

Date of Birth: _____________________________________________________________________

Social Security #: __________________________________________________________________

Phone #: ________________________________________________________________________

Home Address: ___________________________________________________________________

Height: _________ Weight: __________ Hair Color: ___________ Eye Color: ________

Marital Status: ____________________________________________________________________

Spouses Name: __________________________________________________________________

Circle the appropriate title(s): Ordained, Licensed, Commissioned, Volunteer, Financially Supported
Have you applied before? Yes _______ No _______
Have others from your congregation or organization applied? Yes ______ No ______

Name of congregation or organization: _________________________________________________

Address: ________________________________________________________________________

Phone #: ________________________________________________________________________
Please have your pastor, congregation president, chairperson of church board, supervisor,
or the equivalent, or a person in the community who knows about your church, complete
and sign the section below.
I, _______________________, hereby state that the above named person is in good
standing with the congregation or organization and fully approve of him/her serving the
inmates of the Elkhart County Jail on our behalf.

Signed: ___________________________________ Address: ______________________________

Title: _____________________________________ Phone#: _______________________________

For office use only:                                                                                   Affix Photo Here

Date Interviewed:
Interviewer:
Interviewer’s Comments:
Date of tentative approval:
Final Approval Granted:
Jail Commander: