Islamic Chaplaincy Course Registration Chaplaincy Application FormApplicant InformationFirst Name Last Name Email Phone/Mobile AddressAddress Line 1 Address Line 2 City State Zip Code Denominational/Faith/Spiritual Affiliation Please indicate which CPE course you are applying for? Refer to the Chaplaincy page for more information on each course. CPE 1 Full Course ($1800 upfront payment if selected) Introductory CPE Course ($250 upfront payment if selected)EducationPlease provide the name of the highest educational institution you have graduated from.Secondary Tertiary Other: (Please specify) Professional ExperiencePresent Occupation/Vocation Lenght of Time Other significant professional experiences: ReferencesPlease include the names of two referee contacts. References may come from your faith community, professional or academic experience. We will make contact with your referees as needed. Referees may be contacted by ISRA before or after the selection process. Referee 1 Name Email Phone/Mobile Your relationship Years referee has known you Referee 2 Name Email Phone/Mobile Your relationship Years referee has known you Study CreditAre you applying for this CPE unit for tertiary credit? Yes NoWhich course and institution? Payment of FeesShould your application be successful, please indicate who will be paying your fees. (e.g. myself, faith group, academic institution) In-depth QuestionsPlease tell us why you are applying to participate in CPE. (no more than 200 words) Provide an autobiographical statement giving a reasonably full account of your life, including your emotional and spiritual development to the present time, family experience, health problems, educational background and professional goals. (no more than 1000 words) Provide an example of a recent situation where you provided spiritual support. (no more than 500 words) What do you understand the course to be offering you as a participant and what goals do you have for the training unit? (no more than 500 words) Submit Form
