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1
Contact Information
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Payment
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Competencies
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Transcript and Education
5
Clinical
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Endorsement
7
Consent
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*** Once PAYMENT is complete -- return to this form to SUBMIT APPLICATION***
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Your information will not be submitted until you SUBMIT GIFT at the bottom of the form.
Chaplain Competencies Document
Please upload the PDF fillable document which includes written responses of 1200 to 3200 characters for each of the board-certifying chaplain competencies. The responses should show evidence of meeting the competency.
Completed Competencies Document
Max. file size: 50 MB.
Bachelor’s transcript and Master of Divinity transcript.
Bachelor's Degree Transcript
Max. file size: 50 MB.
Master of Divinity Transcript
Max. file size: 50 MB.
Clinical Pastoral Education
Upload certificate showing four units of Department of Education accredited Clinical Pastoral Education.
Clinical Pastoral Education upload
Max. file size: 50 MB.
Clinical Chaplain Work
Upload a document from employer indicating 2,000 hours of clinical chaplain work after completion of four units of Clinical Pastoral Education.
Clinical Chaplain Work
Max. file size: 50 MB.
Faith Group Endorsement and Chaplain Employer Support
Upload official letter of faith group endorsement below. Please also upload a signed letter from the chaplain’s employer about the chaplain’s employer honoring certification from the Evangelical Board of Certified Chaplains.
Faith Endorsement Letter
Max. file size: 50 MB.
Employer Support Letter
Max. file size: 50 MB.
Consent
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By typing my name on this line, I hereby certify the information on this application is true to the best of my knowledge. And I acknowledge that before this application is complete, I will have to submit my social security number upon request for a background check.
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