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Ministerial Studies Enrollment Form
Join the team! (Basic Information about Careers and Training)
Charter & License Application (Receive Referrals as a Charter Member Organization)
Association of Pastoral Counselors
Member and Organization Application
If applicant is ordained or Licensed in another church, attach copy of ordination or license to the application with appropriate fee(s).
$18 Annual plus $5.95 S&H for Certificate of Membership for Individuals. $12 plus $5.95 S&H Annual for students.
Mail To: Our Daily Bread, Missions Organization
Association of Pastoral Counselors
Box 1934
Redmond, OR 97756
Date_____________
1. Personal Information:
A. Name in Full Last_________________First_____________ MI ______
B. Social Security Number _______-_____-_________
C. U.S. Citizen Yes ___ No ___ Country of Citizenship if no________
D. Mailing Address _______________________________________
City__________________ State __________
Zip _________-________
E. Phone: Home _________________
Work ________________ (Optional)
F. Birth date ______________
Birth Place ______________________
G. Male___ Female ____
In case of Emergency _________________
H. Email Address ______________________________
2. Christian Life
A. Briefly on a separate piece of paper, write your testimony.
B. Present Church Membership or affiliation,
Name of Church or Membership ___________________________
Pastors Name ______________________
Address_______________________________________________
3. Education:
Grade School _____________________________________________
High School _____________________________________________
Bible School _____________________________________________
College ______________________________________________
5. References:
1) Name _______________________________________
Address, City, State, Zip ___________________________________
2) Name _______________________________________
Address, City, State, Zip ___________________________________
3) Name _______________________________________
Address, City, State, Zip ___________________________________
Pastor _________________________________________
Address, City, State, Zip ___________________________________
6. Church Affiliation:
Name of church, organization, or charter organization you work for:
__________________________________________________
Address of church or organization:
__________________________________________________
E-Mail Address _____________________________________
Phone ( ) __________-____________________
Certification: I the undersigned have read and agreed to your Articles of Faith and Code of Ethics (Pastoral Counseling Services and Alliance of Accredited Ministers)
Signature ________________________________________
Date ______________________