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Student Application


All items marked with * are required fields.



First, Middle, and Last Name *
Address *
City *
State *
Zip Code *
Country *
Primary Phone # *
Alternate Phone #
E-mail *
Desired Program *
Date of Birth *
Gender *
Marital Status *
High School Diploma Awarded by:?/ Year? *
Associates Degree Awarded by:? /Year?
Bachelor's Degree Awarded by:? /Year?
Master's Degree Awarded by:? /Year?
Doctoral Degree Awarded by:? /Year?
Date you became a Christian? *
Do you hold ministerial credentials? With what organization? *
What church do you attend? *
Do you have a felony conviction? If so, please explain. *
Spouse's name, if applicable.
Your current occupation. *
Briefly tell us about your personal testimony: *
Why do you want to become a counselor? *
What formal or informal training have you already had? *
What are your plans for future ministry? *
Explain your call to a counseling ministry? *
How will you be paying? *
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