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Chaplain Certification Application

This application is required as apart of our entry process for all new students. It helps us determine if you will be a good fit for the program and what additional resources and benefits will apply to you.

Once you have completed the application in it's entirety, the confirmation page will provide any pertinent details. Please be sure to check your email inbox (or SPAM folder) for your acceptance or next steps letter. Upon acceptance, your confirmation email will include payment options and more. If you have been awarded a scholarship or tuition assistance code, your acceptance email will indicate it.

Should you require any further assistance, Email: [email protected] or Text: 252-765-4373

Incomplete applications will not receive a response or be considered.

You will be contacted within 24 business hours of receiving your completed application in order to   finalize your enrollment. BACK TO MAIN WEBSITE HERE

Click the button below to Start Application!

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Question 1 of 33

First Name (As it should appear on your credentials)

Question 2 of 33

Middle Name or Initial (As it should appear on your credentials)

Question 3 of 33

Last Name (As it should appear on your credentials)

Question 4 of 33

Gender

A

Male

B

Female

Question 5 of 33

Birthdate (MM / DD / YYYY)

Question 6 of 33

Please provide the two middle digits of your social security number. (This is only used to create your Student ID - 000-12-0000)

Question 7 of 33

Email  (You may receive communications from us)

Question 8 of 33

Phone Number  (You may receive communications from us)

Question 9 of 33

Address Street | City | State | Zip Code (Required to receive your class materials and some credentials)

Question 10 of 33

What social media platforms are you currently active on?

(Select all that apply)
A

Facebook

B

Instagram

C

TikTok

D

Twitter / X

E

YouTube

F

LinkedIn

G

Club House

H

Other

Question 11 of 33

How did you hear about LTA Chaplaincy Certification Program? (Check all that apply)

(Select all that apply)
A

Alumni Referral

B

Staff Referral

C

Pioneers Conference (North Carolina)

D

Facebook

E

Instagram

F

Email

G

Community flyer

H

LTA Affiliate or Partner

I

YouTube

J

Local Church or Pastor

K

I have no idea!

Question 12 of 33

If you were referred to this program by an Alumni/Student or Instructor/Staff, please list their name (first & last).

Question 13 of 33

Have you graduated College/University (This is not a Prerequisite to be accepted into our program)

A

AA

B

BA/BS

C

MA/MS

D

PhD

E

Currently Attending

F

Never Attended

Question 14 of 33

What field of study is your degree in? (N/A if not applicable)

Question 15 of 33

Have you attended any other ministry schools, seminary, other programs?

A

Yes

B

No

Question 16 of 33

If you answered yes to the previous question: What other programs, seminary or ministry schools have you attended?

Question 17 of 33

If married, will your spouse be attending this Chaplaincy Certification Program? (You may qualify for a scholarship)

A

Yes

B

No

Question 18 of 33

Do you have any family members of your household attending this program with you? If yes, list their First & Last names below. (You may qualify for a scholarship)

Question 19 of 33

Do you have a church affiliation and if “yes” what is the name | city | state?

Question 20 of 33

Do you attend church or a ministry service regularly? (In Person or Online)

A

Yes

B

No

Question 21 of 33

Are you a minister? (This is not a prerequisite. Your active license or certificate would confirm "licensed" or "ordained". If your physical proof has an expired date, please select the appropriate option "C" below)

A

Ordained

B

Licensed

C

My Credentials are Expired

D

None of the above

Question 22 of 33

Please list a pastoral, spiritual or accountability leader reference that can confirm your spiritual development and involvement over the last 2 years in a church, ministry or community aspect.

Question 23 of 33

In what capacity are you currently serving in your local church, ministry or community?

Question 24 of 33

If you are not currently serving in one of the above capacities, please explain why.

Question 25 of 33

Please describe your ministry, volunteer or community experience.

Question 26 of 33

In what capacity do you plan to use your certification and training?

Question 27 of 33

What capacity(s) have you already served or worked as a Spiritual Care Leader?

(Select all that apply)
A

Church

B

Hospital

C

Nursing Home

D

Hospice

E

Prison

F

School

G

Sports

H

Military

I

Police or Fire Department

J

Corporation

K

Performed Weddings

L

Performed Funerals

M

Performed Other Ceremonies

N

Support for Family & friends

O

No capacity yet

Question 28 of 33

Financial Assistance: If funds are available, do you need to apply for a scholarship?

A

Yes

B

No

Question 29 of 33

Financial Assistance: Indicate the category that best describes your status.

(Select all that apply)
A

Married | I am attending the Chaplain Certification with my spouse

B

Household | Someone else in my home will be attending the Chaplain Certification with me

C

Senior | I am 55 years or more on a limited/fixed income

D

None of the Above | I will explain in the next section

Question 30 of 33

Financial Assistance: Why should you be considered for a scholarship award?

Question 31 of 33

Would you like to stay connected in a community of Chaplains and like minded Spiritual Leaders?

A

Yes

B

No

Question 32 of 33

Would you like to receive information that may help you grow in your Chaplaincy endeavors?

A

Yes

B

No

Question 33 of 33

Last thing!

To spread the news about our Academy, we often do special promotions and advertisements. This sometimes includes the use of student photo and name. If you are accepted into the program and desire a scholarship, but do not meet the above criteria, this will help your case. We are asking for your official consent AND support. 

 

Copy and paste this link to give your consent. https://docs.google.com/forms/d/e/1FAIpQLSc8egGFnkp4fsdcnJaMOMf0rzWektwawFMXSrT5CvpdTiG7yQ/viewform?usp=sharing

A

Yes, I will consent to support!

B

No, I neither consent nor support!

C

Maybe Later!

Confirm and Submit