Cross-Cultural Living and Ministry Course Registration Form
$550 ($450 if taken with a language acquisition course)
Name
*
First Name
Last Name
Nickname or name you wish to be called
Email
*
example@example.com
Date of birth
*
-
Month
-
Day
Year
Date
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Phone number
*
Email
*
example@example.com
Agency or Organization
*
How did you hear about this course?
My sending agency
ICCT newsletter or website
Facebook
A friend or colleague
Other
In which month do you plan to begin the course? (Courses are offered at the beginning of each month except for August and December.)
*
At what pace would you like to take the course?
*
1 module (2-3 hours) per week over 11 weeks
2-3 modules (6-8 hours) per week over 4-5 weeks
Not sure
Background Information
Have you ever taken another ICCT course? If so, which course and when?
*
E.g., "Yes, I took SLA for Beginning Learners in the summer of 2019."
Have you ever had difficulty in hearing or speaking your native language? If yes, please describe.
*
E.g., "Yes, I wear hearing aids."
Have you ever had difficulty in reading or writing your native language? If yes, please describe.
*
E.g., "Yes, I have a reading disability."
Besides your native language, have you ever used another language for everyday communication? If yes, please describe.
*
E.g., "Yes, I lived in Spain for a study abroad semester and took classes in Spanish."
What significant cross-cultural experiences have you had? Please list them below and state the effect that you believe these experiences will have on your future cross-cultural learning.
*
E.g., "I had a month-long cross-cultural internship in Belgium in 2016 in which I attended a national church, took classes in language and culture acquisition, and did cultural observations."
Please describe any previous coursework you have had in cross-cultural communication, cultural anthropology, missions courses with a culture component, etc.
*
In your academic study, did you major or minor in a foreign language? If so, which language(s)?
*
In which country or countries do you expect to work?
*
Briefly describe what your role will be in the target culture.
*
Learning Contract
If you are accepted for enrollment in this course, do you agree to do the required work and give more time if needed?
*
If you are accepted for enrollment in this course, do you agree to do all required assignments in a timely manner?
*
Will you have other heavy responsibilities such as work, church commitments, or travel during the time you plan to take this course? If yes, list your commitments and the approximate amount of time involved.
*
Thank you for your registration. We will send you an email verifying your acceptance and including payment information. Once your payment has been received, you will be given access to the course. If you have any questions, please contact us at ict@wheaton.edu.
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