Enrollment Application

Full Name(required)

Address line 1(required)

Address line 2

City/town(required)

State/Province(required)

Zip/Postal Code(required)

Country(required)

Preferred Phone Number(required)

Email Address(required)

Date of Birth (00/00/0000):(required)

High school diploma awarded by & graduation year:(required)

Associate's degree awarded by & graduation year:

Major:

Bachelor's degree awarded by & graduation year:

Major:

Master's degree awarded by & graduation year:

Major:

Doctoral degree awarded by & graduation year:

Major:

How did you become a Christian?(required)

What year did you become a Christian?(required)

Do you hold ministerial credentials? If so, what are they?(required)

If so, by whom and when were they granted?

Any felony convictions in your past? Explain...(required)

What is your current occupation?(required)

Why do you want to become a Christian Counselor, Coach, Minister, or train further in this field?(required)

What training in this field, if any, have you already had?(required)

What experience have you had dealing with the emotional and spiritual issues of other people?(required)

Please share your immediate goals for your counseling, coaching, or pastoral ministry:(required)

Do you plan to be involved in an existing ministry, or are you considering establishing a ministry?(required)

Please share how you discovered Reality Counseling Center (search engine, a friend, a minister, etc):(required)

Any other remarks, suggestions, questions, or anything else we should know?

Reality Counseling Center