• Counseling Ministry Application

  • Personal Information

  • Gender*
  • Marital Status*
  • Format: (000) 000-0000.
  • Birthday*
     - -

  • Education

    Please include name of institution and dates attended.
  • Have you completed Equipped to Counsel?*
  • Are you certified with ABC?*
  • Have you provided biblical counseling at another ministry/organization in the last 5 years?*

  • Applicant Questions

  • For which of the following problems would the Word of God have sufficient answers to address and help the person to change?  (check all that apply)*
  • Are you involved in sinful conduct or do you have unresolved conflicts, which if known, would cause others to question the appropriateness of you being an SHC Counselor?*
  • Have you ever been placed under church discipline?*
  • Are you listed on the Public Sex Offender Registry?*
  • Have you ever been convicted of a felony?*

  • Commitment

  • Can you commit to the time needed each week to pray, prepare, counsel, and complete reports? (Minimum of 3 hours per week)*
  • Can you commit to furthering your biblical counseling education by attending monthly Equip and Encourage Meetings (one Sunday a month @ 5-6:30pm) and additional counselor workshops and trainings (at least 2 times per year)?*
  • I would be interested in serving as (check all that apply):*

  • Biblical Counselor Release

  • I recognize that Salem Heights Church Biblical Counseling is relying on the accuracy of the information I provide on this Biblical Counselor Application form. Accordingly, I attest and affirm that the information I have provided is absolutely true and correct.  
    I authorize Salem Heights Church Biblical Counseling to contact any person or entity listed on the Biblical Counselor Application form, and I further authorize any such person or entity to provide the organization with information, opinions, and impressions relating to my background or qualifications.  


    I voluntarily release Salem Heights Church Biblical Counseling and any such person or entity listed on the Biblical Counselor Application form from liability involving the communication of information relating to my background or qualifications. I further authorize the organization to conduct a criminal background investigation.  


    Should I be selected to be a biblical counselor, I agree to abide by the policies and procedures of the organization and to protect the health and safety of the counselees assigned to my care at all times.  

  • Date*
     - -
  • Should be Empty: