Referral Form – GF.wels.net

Complete this referral form to provide contact information for yourself or someone else to receive ministry in one of the areas of ministry indicated. A field marked with a red asterisk * is required.
Select one ministry*
- WELS Intellectual and Developmental Disabilities (IDDM)
- WELS Prison Ministry
- WELS Mission for the Visually Impaired (MVI)
Change request
Are you reporting an update to previously submitted information?
- Check box if you are requesting an update to information already submitted.
Other Special Ministries Referrals

WELS Special Ministries provides resources and guidance for people who face barriers such as disabilities (hearing loss, intellectual or developmental disabilities, mental health issues or other challenges). If you know someone who is experiencing a barrier to participating in worship or other church life, you can ask questions or tell us about this person's needs by using the Contact Us form.
Who is submitting this Referral Form?*
- I am submitting my own information.
- I am submitting information for someone else.
Is the person you are referring an European Union (EU) resident?*
- Yes
- No
We are not able to send materials to European Union (EU) residents without their expressed permission according to the European Union's General Data Protection Regulation (GDPR). EU residents may request our materials directly by contacting WELS via our Contact Us form.
If you are submitting information for someone else, we may need to ask you for more information. Please provide us with your contact information.
Full name of person submitting the form*
Phone number of person submitting the form
E-mail of person submitting the form*
Relationship*

Complete the following fields for WELS Mission for the Visually Impaired (MVI)
Name of person who is visually impaired or print impaired*
First Middle Last Suffix
Address*
Address line 1 Address Line 2 City state/Provence ZIP Country
Phone
E-mail 1*
E-mail 2 (optional)
Which of these kinds of resources can this person use? (select all that apply)*
- Select All
- Audiobook
- Braille
- Large print
Is this person visually impaired or print impaired?*
- Print impaired
- Visually impaired

Complete the following fields for WELS Intellectual and Developmental Disabilities (IDDM) ministry
Name*
First Middle Last Suffix
Gender
Marital status
Birth date
Mailing address
Address line 1 Address line 2 City State/Province Zip/Postal code Country
Living situation
Please explain*
Residence address (if different from mailing address)
Address line 1 Address line 2 City State/Province Zip/Postal code Country
Guardian Information
Consent from the Guardian is required for us to complete the referral process. Please provide as much information as possible to expedite this process.
Do you or the person you are referring have a legally appointed guardian?*
- Yes
- No
- I am unsure
Legal guardian
- I am the legal guardian
- I am not the legal guardian
Guardian name
First Last
Guardian mailing address
Address line 1 Address line 2 City State/Province Zip/Postal code Country
Guardian e-mail
Guardian phone
Other information

WELS Special Ministries assists local congregations in serving their members and wishes to keep the church informed of our contacts with their members. Please provide information regarding the church of which this person is a member, if any.
Church name
Pastor's name
City
State/Province
Data Privacy & Permission*
I AGREE with the terms of the WELS Privacy Policy.
NOTE TO EU CITIZENS, RESIDENTS, TOURISTS, AND OTHER PERSONS TEMPORARILY IN THE EU:

By submitting this form you consent to any and all information you provide and submit via the site being sent to the United States of America. The United States has not sought nor received a finding of “adequacy” from the European Union under Article 45 of the GDPR. WELS relies on derogations for specific situations as set forth in Article 49 of the GDPR. You are also informed that the United States presently does not have an adequate level of personal data protection as determined by the European Commission’s adequacy decision on October 6, 2015 (case c-362/14) and articulated in the European Union’s General Data Protection Regulation and has not received a similar designation of adequacy by any other foreign data protection authority. You agree to the transfer of your data and personal data to the United States, however, to be used in accordance with WELS Privacy Policy.