Course Application - Christian Psychology Institute

Course Interest Form

Complete and submit the form below and we will review your application.

Phone

This field is for validation purposes and should be left unchanged.

Course(Required)

Course 1: Worldviews, Ethics, & Distinctly Christian Therapy

Course 2: Human Nature and Christian Healing and Formation: A Framework for CCT

Course 3: A Theology for Counseling – Part 1

Course 4: A Theology for Counseling – Part 2

Email(Required)

Full Legal Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Educational Background (Optional)

College Degree(Required)

Master's/Doctoral Degree (If Applicable)

Certifications (If Applicable)

Have you taken any classes or seminars in Psychology? (If Applicable)

Employment Background (Optional)

Relevant Past Employments & Volunteer Positions

Current Employment(Required)

Professional Title

Organization/Practice Name(Required)

What is your primary area of focus in your practice? (e.g., counseling, psychiatry, social work, school psychology)(Required)

How many years have you been practicing in the field?(Required)

Are You Currently Licensed?(Required)

Yes

What populations do you primarily serve?