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Home
About The NACC
Training
Counseling
- Find A Counselor
Donate
Contact

Enroll Online

To enroll online, simply fill out the online enrollment form below.

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. All fees are nonrefundable and nontransferable.

Applicant Name

First Name*

Middle Initial

Last Name*

Personal Information

Date of Birth

Social Security Number (USA)

Social Insurance Number (Canada)

Govt. I.D. No. (Other Countries)

Street Address*

City*

State*

Country*

Postal/Zip Code*

Email*

Telephone*

Professional Information

Institution/Church/Center*

Work Position*

Field of Service where you are actively providing pastoral care that is consistent with a Christian vocation*

Work Address*

Work City*

Work State*

Work Zip Code*

Work Phone*

Mobile Phone

Pager Numer

Fax Number

Current Work Supervisor's Name, Address, and Phone Number

Faith Group Affiliation*OrdainedLicensedCommissionedNone

Recognized By

Place and Date

Academic History

College

Date Completed

Degree & Major

Seminary

Date Completed

Degree & Major

Graduate Study

Date Completed

Degree & Major

Clinical Pastoral Education or Pastoral Counseling Training

Dates

Center

Supervisor

Dates

Center

Supervisor

Ministerial Experience

Church/Institution

Place

Dates

Church/Institution 2

Place 2

Dates 2

Church/Institution 3

Place 3

Dates 3

Questionnaire

Program of Interest (choose one)*

Which class are you interested in? (choose one)*

Who is your Class Instructor?

Summarize your approach to counseling*

State your view of Christian counseling*

Briefly explain your conversion to Christ*

State your reasons for desiring to be an NACC Certified Christian counselor*

Have you ever applied to be a NACC certified counselor?NoYes

If yes, when and why was it not completed?*

Name of church or agency under whose authority you currently counsel

Are you involved in sinful conduct or do you have unresolved conflicts, which if known, would cause others to question the appropriateness of your being an NACC counselor?NoYes

Please explain*

Have you ever been placed under Church discipline?NoYes

What was the outcome?*

Are you listed only Public Sex Offender registry?NoYes

Please explain*

Have you ever had a felony conviction?NoYes

If YES, please describe the nature of the conviction*

Date of Conviction*

Is the church or ministry under whose authority you counsel aware of it?NoYes

Are there protections in place to prevent scandal if and when a question is raised about this?NoYes

What state or federal guidelines apply to you?*

Are you complying with all applicable state and/or federal guidelines?NoYes

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NACC

The NACC is a Christian service organization committed to the Lord Jesus Christ and we believe that unless counseling is founded upon and directed by the Word of God, it is in vain.

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Mailing Address:
9212 Fry Rd Ste 105 #410
Cypress, Texas 77433

Contact Information:
Phone: 281-936-0351
Email: [email protected]

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