Lay Counseling Program - Application

The three mandatory LCP weekend classes will be held on the following dates:

September 14 - 16, 2017

January 18 - 19, 2018

April 19 - 21, 2018

*
First Name
Middle
Last Name
Maiden(s):
Address: *
Phone:*
Email:*
Date of Birth:*
Gender:*
If you have lived in another state in the last 5 years, please list the city(s) and state(s)
AUTHORIZATION: I authorize Christ The Rock Community Church or its representatives to make any and all appropriate inquiries regarding my background information including indicated references and criminal history record. I release the church and its representatives from any liability which may result from such actions. The information I have provided is correct.
Signature:*
Date:*
If there is anything you would like to explain that may appear on your background record, please do so on a separate document via email to dvanthiel@christtherock.org.
Occupation:*
Employer*
Number of years employed:
Marital Status: *
If married, spouse's name:
Number of years married:
If divorced, number of years divorced:
Number of children:*
How long have you been a Christian?*
Name of church you are currently attending:*
If you attend CTR, are you a member?
Do you attend CTR?
List past and currently areas of ministry/involvement:
Have you had involvement (and commitment) to a home fellowship group, Bible study or other similar accountability-type group?*
If yes, list type, location and how long:
Briefly described your interest in LCP and your reasons for applying: *
Have you completed a Leadership Questionnaire?*
If yes, what ministry were you involved with at CTR that required your completion of the leadership questionnaire?
Have you ever received counseling or therapy?*
If yes, when, where and why?
Do you have any current medical or emotional problems that require treatment or medications?*
If yes, please list:
Please list any prior counseling training you have had. When and where?
Level of Education Completed. *
For college, list number of years completed and diploma received:
List any other special training:
Have you completed Character Development?*
What is (will be) your completion date:*
Who was your small group leader in Character Development?*
Can we contact your Character Development Small Group Leader as a reference?*
If married, is your spouse supportive (aware) of your time commitment to LCP?
Please list TWO Character/Spiritual references (not family) that we can contact. List their name, email address, address, Phone, relationship and how long you have known them.
Reference #1 *
Reference #2: *
*