Follow the steps to complete your application accurately.

1. Click 'Get Form' button to obtain the application and open it in the editor.
2. Fill in your personal information, including your name, address, phone number, and date of birth. Ensure all fields are completed clearly and legibly.
3. Indicate your residency and citizenship status by selecting 'Yes' or 'No' for each question provided.
4. Detail your educational background. List your schools, degrees earned, and dates of attendance. Remember to submit any required transcripts.
5. Provide information on your clinical pastoral education, including completion details and any certificates from recognized agencies.
6. Complete the ecclesiastical status section, listing your church membership, ordination details, and endorsing agency with their addresses.
7. Document your professional counseling experience and any licenses or certificates you hold. Attach copies of these documents where indicated.
8. List three references who can attest to your qualifications, including their names, contact information, and relationship to you.
9. Attach a recent photograph and include the required application fee, noting that personal checks will not be accepted. Ensure this is in the form of a cashier's check or money order.
10. Carefully read through the affidavit section, sign it to affirm the truthfulness of your statements, and ensure it is notarized.
11. After completing the application, save any changes, and download or print the form for your records before mailing it to the specified address.

Start filling out your application online today to take the next step in your certification journey.