APPLICATION Contact InformationWhat are you applying for?*Residency Week And Full CertificationAudit ResidencySelect Residency Week:*November 9-13, 2020 - First Baptist Church Jonesboro, GeorgiaDecember 1-3, 2020--Special Zoom Residency limited to 2 studentsJanuary 26-28, 2021--Special Zoom Residency limited to 3 studentsFebruary 22-26, 2021--Georgia (Atlanta area) Location to be announceMarch 22-26, 2021--Rockaway Beach, Missouri--Bridge of Faith ChurchMarch 30-April 1, 2021--Special Zoom Residency limited to 3 studentsJune 21-25, 2021--Georgia (Atlanta area) Location to be announcedSeptember 13-17, 2021--Georgia (Atlanta area) Location to be announcedNovember 8-12, 2021--Georgia (Atlanta area) Location to be announcedName* First Last Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Cell Phone*Home PhoneWork PhoneEmail* GenderMaleFemaleAge*DOB*mm/dd/yyyySpiritual HistoryChurch Home:*Denomination*EducationYear Graduation From High School:*Highest level of college completed:Post graduate degree(s):Criminal HistoryHave you ever been convicted of a felony?*NoYesQuestionnaireProvide your testimony in regard to receiving Jesus Christ as your Lord and Savior and describe your relationship with Jesus Christ.*Do you currently have any formal training or experience in counseling?*Why do you want to be a counselor?*Please describe your relationship with your home church?*How did you learn about our program?*Agreement and SignatureBy submitting this application, I affirm that the facts set forth in it are true and complete.Printed NameDate* Date Format: MM slash DD slash YYYY Signature*UntitledFirst ChoiceSecond ChoiceThird Choice No payment is due at the time of the application. You will be invoiced for the deposit amount. Contact InformationWhat are you applying for?*Residency Week And Full CertificationAudit ResidencySelect Residency Week:*November 9-13, 2020 - First Baptist Church Jonesboro, GeorgiaDecember 1-3, 2020--Special Zoom Residency limited to 2 studentsJanuary 26-28, 2021--Special Zoom Residency limited to 3 studentsFebruary 22-26, 2021--Georgia (Atlanta area) Location to be announceMarch 22-26, 2021--Rockaway Beach, Missouri--Bridge of Faith ChurchMarch 30-April 1, 2021--Special Zoom Residency limited to 3 studentsJune 21-25, 2021--Georgia (Atlanta area) Location to be announcedSeptember 13-17, 2021--Georgia (Atlanta area) Location to be announcedNovember 8-12, 2021--Georgia (Atlanta area) Location to be announcedName* First Last Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Cell Phone*Home PhoneWork PhoneEmail* GenderMaleFemaleAge*DOB*mm/dd/yyyySpiritual HistoryChurch Home:*Denomination*EducationYear Graduation From High School:*Highest level of college completed:Post graduate degree(s):Criminal HistoryHave you ever been convicted of a felony?*NoYesQuestionnaireProvide your testimony in regard to receiving Jesus Christ as your Lord and Savior and describe your relationship with Jesus Christ.*Do you currently have any formal training or experience in counseling?*Why do you want to be a counselor?*Please describe your relationship with your home church?*How did you learn about our program?*Agreement and SignatureBy submitting this application, I affirm that the facts set forth in it are true and complete.Printed NameDate* Date Format: MM slash DD slash YYYY Signature*UntitledFirst ChoiceSecond ChoiceThird Choice No payment is due at the time of the application. 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