Certificate Request

Please write your name EXACTLY how you want it printed on your certificate.(Required)

Address(Required)

Street Address City, State [or City, Province] ZIP or Postal Code Country

Please write your address as you want it printed on the envelope that we will mail your certificate in. Please use the correct capitalization and spelling to ensure the certificate reaches its destination successfully.

What is the email associated with your student account?(Required)

Are you requesting a certificate from the old program structure (pre-2022) or the new program structure?(Required)

Old Program

New Program

Choose one or more of the follow certificates to request.(Required)

Foundations of Biblical Counseling (old program)

Topics in Biblical Counseling (old program)

Counseling Skills and Practice (old program)

Choose one or more of the follow certificates to request.(Required)

Formation Certificate

Essentials of Biblical Counseling Certificate

Pastoral Reference

Please share the contact information for your pastoral reference. Please note: this reference cannot be yourself or a relative. If you are a pastor or are related to the pastor of your church, please provide the name of either another elder or someone who knows you well who can be your reference.

Name of Pastoral Reference(Required)

First Last

Email of Pastoral Reference(Required)