ISCT
STUDENT APPLICATION

Note: Registration deposit is nonrefundable.

NOTE:   Students of Providence Bible College and Theological Seminary are not required to pay registration fee unless the course you are registering for at this time is not a PBC course.   PBC students are required to purchase the Student Packet for the course.   Send one copy with your check or international postal money order in the amount of $35.00 (U.S. Funds) payable to COUNSELSOURCE.   Materials and Login password will be sent to your Email address.   Please enter Email address here.

Your personal information
Your Name :
Present
address :
City : State :  Zip :
Country :
 Mail delivery code if outside United States :
Telephone with area code (country code outside United States)

Male     Female


Your Social Security Number
 (United States) :
 Your National Identity Number
 (Country other than United States) :


Please list your permanent address if different from above.
Permanent
address :
City : State :  Zip :
Country :
 Mail delivery code if outside United States :
Telephone with area code (country code outside United States)


Your Denomination/Faith Group affiliation

OR
Other (please specify) :

Your present position or job title :

Have you been ordained ? Date :

Name of ordaining organization or church :

Are you currently serving in a church ? For how long ?

EDUCATION :Name of SchoolDegree & major
College :
Seminary :
Graduate :

References

Pastoral reference should know you well enough to evaluate your spiritual maturity.
Pastoral
Reference :		 Pastor or denomination official
Name :
Address :
City : State :  Zip :
Country :
 Mail delivery code if outside United States :
Telephone with area code (country code outside United States)

Academic reference should know you well enough to evaluate your potential to successfully complete a challenging academic program.
Academic
Reference :		 Professor ot teacher
Name :
Address :
City : State :  Zip :
Country :
 Mail delivery code if outside United States :
Telephone with area code (country code outside United States)

Personal reference should know you well enough to evaluate your personal integrity and social skills.
Personal
Reference :		 Friend or co-worker
Name :
Address :
City : State :  Zip :
Country :
 Mail delivery code if outside United States :
Telephone with area code (country code outside United States)

PREVIOUS TRAINING IN CLINICAL PASTORAL COUNSELING :
DatesSupervisorClinic/Church
1.
2.
3.
4.

1. A reasonably full account of your life, include:
  • important events,
  • relationships with people who have been significant in your life,
  • and the impact these events and relationships have had on your personal development.
  • Describe your family of origin (or adopted family),
  • your current family relationships and your educational growth.


2. A description of the development of your religious life, include:
  • events and relationships that formed your faith,
  • an event or relationship that has most affected your worldview,
  • an event or relationship that has recently confirmed or changed your worldview,
  • and your own assessment of your personal spiritual maturity.


3. A description of the development of your work (vocational/career) history, include:
  • a chronological list of positions and dates,
  • a statement of your vocational/career goals,
  • and a brief description of the job that would be perfect for you.


4. An account of an incident in which you "counseled" someone, include:
  • the nature of the request (how it was presented to you),
  • your assessment of the "problem,"
  • your response and "interventions",
  • and a summary evaluation.
If you have had previous clinical or pastoral counseling experience, include this information. If you have actually managed a case of counseling someone, summarize the case from "intake" to "discharge or termination."


5. Your impression/definition of Clinical Pastoral Counseling (clinical theology), include:
  • your educational goals,
  • how this training will be used to meet your educational goals,


6. Your personal and professional (ministry) goals, include:
  • How this training will further your professional goals?
  • Why you chose ISCT?


Questions or Comments -- How can we help you  ?   ?

  
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