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Supplemental Questionnaire

Last Name
First Name


***Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.***


Do you have a Bachelor's degree in the disciplines of Theology, Religious Studies, or Sacred Studies from an accredited institute, seminary, or equivalent? If you do not have this experience, enter N/A.


Do you have at least one year experience specifically counseling others or completion of one course in Clinical Pastoral education? Include the name of employer(s) and dates of employment when you performed these duties. If you do not have this experience, enter N/A. 

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