Preferred Title: Mr., Mrs., Ms, Rev, Pastor, Rabbi, Elder, Imam, Father, Sister, other
Name - First, Middle Initial, Last:
Email Address:
Best Phone Number
Would like a member of the seminary team to call you? Yes, please
Not at this time, thank you
Subject(s) of interest
After completion of study, what is your goal?
Apt. / Unit #
City / Town name:
State / Province:
Zip / Postal Code
Country / Nation:
I am interested in the following (it is fine to select more than one button) Chaplaincy Training
Ordination to clergy
Griefworker Training
Earn CPE units
Bachelors degree
Masters degree
Doctoral degree
Women's Studies
Social Justice
Pastoral Counseling
Pastoral Management
Social Worker
Elder Chaplaincy
Fire/PD/EMT Chaplaincy
Spiritual Formation
Animal Ministry
Small Radio/TV station
Have Internet? Yes
Have a computer and are comfortable with its use? Yes
Faith? (Protestant, Catholic, Jewish, Other:
Denomination (Okay if none)
Occupation (if any):
Job Title or Description of your Duties:
Seeking a Promotion in Current Job? Yes
maybe - Undecided
I am just looking Yes
Seeking a Career Change? Yes
Maybe - undecided
I am seriously considering enrolling in an online course at the seminary Yes
Please consider sending a RESUME. It would help us if we could see your background collected in one convenient place. Even if you have only an older version of a resume, that is fine! We are only going to use it as an outline as to how you "got here" and as a means of helping us understand ways we might be able to assist you as you move forward with your career. Thank you!
Name of EMPLOYER (official company name). Please estimate year started working there
Education: If you did not complete High School, please share that information. Give details, only if desired. Not completing high school will NOT exclude you from enrollment in the seminary
GED - You may give further information if desired. This can be useful in helping you decide which subjects will be useful to you
Technical school or special studies: Describe, please. Also, did you complete these studies? Give the year you concluded these studies:
Bachelor's Degree - major - did you complete? How many credits did you earn?
Exact name(s) of College or University where you earned Bachelors - if applies. What was your major? Year graduated:
Master's degree - major - did you complete? How many credits earned?
Exact name of Masters college/university -- and department name (if applies)
Doctoral studies - major - completed? Current status
Please attach a RESUME if available
I will be able to pay my full tuition upon enrolling (typical) Yes
I will need to request your interest-free tuition donation program Yes
One final detail and then you're done. Please give us a description of the type of studies you hope to enroll in at the seminary. And, of course, please use this space to ask any questions you may have!
Other things you would like to bring to our attention:
Clinical Pastoral Education Training Institute of North America
  •   In "Subject" box, please let us know what you are seeking, say, 1, 2, or 3 CPE Units
  •  In "Message Box," please share any comments you may have, or ask questions.
Thank you!
   Clinical Pastoral Education
       Training Institute
  •  Study online for CPE units
  •  Interest-free tuition financing