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Home
About The NACC
Who We Are
Board of Examiners
Join The NACC
Enroll Online
Certification Renewal
Code of Ethics
Training
Zoom Class Enrollment
NACC Training
Certified Training Center
Licensed Therapist
Resources
NACC Affiliate Organizations
International Partnership
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.
Phone
Applicant Name
First Name
*
Middle Name
Last Name
*
Personal Information
Street Address
*
Street Address 2
City
*
State
*
Zip Code
*
Home Telephone
*
Email
*
Date of Birth
*
Social Security Number (USA)
Social Insurance Number (Canada)
Government I.D. Number (Other Countries)
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
*
- Select Province/State -
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
====================
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Work Zip Code
*
Work Phone
Mobile Phone
Pager Number
Fax Number
Current Work Supervisor's Name, Address, and Phone Number
Faith Group Affiliation
*
Ordained
Licensed
Commissioned
None
Recognized By
Place and Date
Education
College
Degree & Major
Date Completed
Seminary
Degree & Major
Date Completed
Graduate Study
Degree & Major
Date Completed
Clinical Pastoral Education or Pastoral Counseling Training
Number of CPE Units Completed
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
Application for Christian Counseling
Questionnaire
Program of Interest (choose one)
*
Board Certified Christian Counseling Certification
Anger Management Certification
Certificate in Marriage and Family Ministry
Board Certified Pastoral Counseling Program
Domestic Violence Certificate Program
Which class are you interested in? (choose one)
*
Zoom Class
Online Class
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?
No
Yes
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?
No
Yes
Have you ever been placed under Church discipline?
No
Yes
Are you listed only Public Sex Offender registry?
No
Yes
Have you ever had a felony conviction?
*
No
Yes
Please review your application. If everything is accurate, please submit the form below.
If everything is accurate, please submit the form.
