Your Denomination/Faith Group
Please choose one
Advent Christian (ADC)
African Methodist Episcopal (AME)
American Baptist Churches/USA (ABC)
American Baptist Association (ABA)
Anglican (A)
Apostolic Faith (AF)
Assembly of God (AG)
Associated Reformed Presbyterian (ARP)
Association of Unity Churches (AUC)
Baptist (B)
Baptist General Conference (BGC)
Baptist Missionary Association of America (BMAA)
Brethren in Christ (BC)
Canadian Baptist (B-Can)
Church of the Brethren (CBr)
Church of Christ (CC)
Church of God (CG)
Church of the Nazarene (CN)
Christian and Missionary Alliance (CMA)
Christian Church/Church of Christ (Independent) (CCInd)
Christian Church of North American (CCNa)
Christian Reformed (CR)
Congregational Christian Church (CCC)
Conservative Baptist (CB)
Conservative Congregational Christian Conference (CCCC)
Cumberland Presbyterian (CP)
Disciples of Christ (D)
Dutch Reformed (DR)
Eastern Orthodox (EO)
Episcopal (E)
Evangelical Covenant (EC)
Evangelical Free Church (EFC)
Evangelical Mennonite (EM)
Free Methodist (FM)
Free Will Baptist (FWB)
Friends (F)
Full Gospel (FG)
Greek Orthodox (GO)
Independent Baptist (IB)
Independent Fundamental Churches of America (IFCA)
International Church/Four Square Gospel (ICFS)
Jewish (J)
Evangelical Lutheran Church in America (ELCA)
Lutheran Church Missouri Synod (LCMS)
Mennonite (Men)
Moravian (Mor)
National Association of Congregational Christian Churches (NACCC)
National Baptist Convention (NBC)
Nazarene (N)
Nigerian Baptist (NB)
North American Baptist (NAB)
Presbyterian Church of East Africa (PCEA)
Presbyterian Church USA (PCUSA)
Progressive National Baptist (PNB)
Reformed Church in America (RCA)
Reformed Judaism (RJ)
Reformed Presbyterian Evangelical Synod (RPES)
Roman Catholic (RC)
Russian Orthodox (RO)
Salvation Army (SA)
Southern Baptist Convention (SBC)
Seventh Day Adventists (SDA)
Seventh Day Baptists (SDB)
Uniting Church of Australia (UCA)
United Church of Christ (UCC)
United Church of Canada (UCCan)
United Church of Christ/Philippines (UCC-Ph)
United Methodist Church (UMC)
Unitarian-Universalist (UU)
Wesleyan Church (WC)
Other
OR
Other (If "Other" please specify) :
Name of your counseling ministry (if different from church name) :
Number of counselors on staff (counting yourself) :
Approximate number of clients per week:
How long has the counseling ministry operated?
Please choose one
Planning stage only
1 year or less
1 to 3 years
3 to 5 years
5 years or more
Your highest earned academic degree and in what major
(For example: MA in counseling) :
Your Name :
E-mail Address :
Your Job Title :
Church name (or where you attend):
Your Mailing Address:
City:
State:
Zip Code:
Country:
Telephone Number:
Fax Number:
Approximate number of members (If you counsel in a church) :