REGISTRATION

ON-LINE SEMINARY OUR CHURCH ABUSE COUNSELING Honorary Doctorates Application Guidelines Accreditation DIPLOMATE The Saint Vital Links Fr. Ewart's Resume M.A.-Ph.D. in Christian Counseling THE MAKING OF A COUNSELOR Master's--D.Min Bachelor's in Christian Education

St. James the Elder Theological Seminary
Registration for honor of Diplomate
c/o St. James Catholic Charismatic Church 7613 Jasper Avenue, #247, Jacksonville, FL 32211
904-724-3536

PRINT THIS PAGE AND MAIL OR E-MAIL BACK WITH SIGNATURE to Fr. Ewart (heywardewart@bellsouth.net)

Your profession/occupation___________________________________

Last name_____________________First____________________Middle___________Sex_____

Address_______________________________________________________________________

Phone________________email________________________Date of birth______________

Website (if applicable)_________________________________________________

Church affiliation______________________________________________________

--NOTE—If you are emailing a resume, and the following are covered thereon, enter "SR"

Highest academic level, field of study, institution_________________________________________________________________

List any licenses or certificates you hold____________________________________________
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Describe any awards, honors, or other recognitions for your professional or volunteer work:

__________________________________________________________________

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Describe your humanitarian service and time period(s)_______________________________________________________________________________

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Have you ever been convicted of a felony or professionally disciplined? ______(yes/no)

If yes, explain briefly______________________________________________________________
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Will you be sending a color photograph of yourself?____

Affirmations

By submitting this form I affirm and acknowledge that:

The information I have provided is truthful.

I will obey all laws of my state and the federal government in my service.

I will hold harmless St. James Catholic Charismatic Church and the Catholic Charismatic Church world-wide in any legal matter.

I will furnish proof of professional liability insurance if it is recommended for my type of service.

I will not exceed my competency level in my performance of service.

I will be true to my calling to which our Lord God has entrusted me.

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Signature/Date

SUGGESTED DONATION: $50.00