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Enroll Online

To enroll online, simply download the application, fill it out, and return it – OR – you may fill out the online enrollment form below.

Download Application
To pay for enrollment, please use the PayPal button below. Upon clicking it, you will be redirected and allowed to enter in the amount of your enrollment.

    Full Name *
    Email Address *
    Referral Name *
    Date of Birth *
    Address *
    Phone Number *
    Occupation *
    Previous Degrees / Certification *
    Church Home and Location *
    Name of Pastor / Bishop / Priest *
    Name as you wish to appear on certificate *
    Program of Interest * (choose one) Board Certified Counseling CertificationAnger Management CertificationDomestic Violence Certification