Islamic Chaplaincy Rego page

Islamic Chaplaincy Course
Registration

Chaplaincy Application Form

Applicant Information

First Name

Last Name

Phone/Mobile

Address

Address 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)

Education

Please provide the name of the highest educational institution you have graduated from.

Secondary

Tertiary

Other: (Please specify)

Professional Experience

Present Occupation/Vocation

Lenght of Time

Other significant professional experiences:

References

Please 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

Phone/Mobile

Your relationship

Years referee has known you

Referee 2 Name

Phone/Mobile

Your relationship

Years referee has known you

Study Credit

Are you applying for this CPE unit for tertiary credit?

Yes

Which course and institution?

Payment of Fees

Should your application be successful, please indicate who will be paying your fees. (e.g. myself, faith group, academic institution)

In-depth Questions

Please 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)

Islamic Chaplaincy Course
Registration

Applicant Information

Education

Professional Experience

References

Study Credit

Payment of Fees

In-depth Questions

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Contact Information

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Contact Information

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Islamic Chaplaincy Course Registration

Applicant Information

Education

Professional Experience

References

Study Credit

Payment of Fees

In-depth Questions

Staff Login

Contact Information

Subscribe for emails so you can get updates and stay connected.

Staff Login

Contact Information

Sign up to stay connected

Islamic Chaplaincy Course
Registration