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Church Chaplain Certification Application

This application is required as a part of our entry process for each new student (including members enrolling as a group). 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, you will receive a confirmation email with payment options and more.

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

You will receive a response within 24-72 business hours of your completed application.

Incomplete applications will not receive a response or be considered.

Click the button below to Start Application!

Start

Question 1 of 35

How are you enrolling into the program?

A

Attending with a Group of 6 or more

B

Attending as an Individual

Question 2 of 35

If you are attending the Chaplaincy Certification Program with a group of 6 or more, please list the group name OR leader's name below. (Church | Non-Profit | Para-Ministry | Faith Group)

Question 3 of 35

First Name (As it should appear on your credentials)

Question 4 of 35

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

Question 5 of 35

Last Name (As it should appear on your credentials)

Question 6 of 35

Gender

A

Male

B

Female

Question 7 of 35

Birthdate (MM / DD / YYYY)

Question 8 of 35

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

Question 9 of 35

Email

Question 10 of 35

Phone Number

Question 11 of 35

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

Question 12 of 35

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 13 of 35

Have you graduated College/University?

A

AA

B

BA/BS

C

MA/MS

D

PhD

E

Currently Attending

F

Never Attended

Question 14 of 35

If you answered yes to the previous question, in what field of study did you obtain your degree?

Question 15 of 35

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

A

Yes

B

No

Question 16 of 35

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

Question 17 of 35

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

A

Yes

B

No

Question 18 of 35

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 35

Do you have a church affiliation and if “yes” what is the name | city | state? (Feel free to skip this, if you indicated your group above)

Question 20 of 35

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

A

Yes

B

No

Question 21 of 35

Are you a minister? (This is not a prerequisite. Your active license or certificate would confirm "licensed" or "ordained")

A

Sr. Pastor

B

Associate Pastor

C

Ordained Minister

D

Licensed Minister

E

My Credentials are Expired

F

None of the above

Question 22 of 35

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 35

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

Question 24 of 35

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

Question 25 of 35

Please describe your ministry, volunteer or community experience.

Question 26 of 35

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 27 of 35

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

Question 28 of 35

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

Question 29 of 35

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 30 of 35

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

A

Yes

B

No

Question 31 of 35

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 32 of 35

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

Question 33 of 35

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

A

Yes

B

No

Question 34 of 35

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

A

Yes

B

No

Question 35 of 35

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

Confirm and Submit