Luther Rice Practicum Application

Luther Rice Practicum Application

Please fill out ALL 3 sections of the application below

Applicant Information (click to expand)
Applicant Name*

First NameLast Name
Biological Gender*
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Zip Code / PostalCountry
E-mail*

Confirmation Emailexample@example.com
Mobile Number*

Country CodeArea CodePhone Number
Marital Status*
Married with kids includes any kids on the way!
Emergency Contact Information*
Please provide the name, relationship, email, and phone number of your emergency contact.
Class hours have you completed?*
How many actual completed hours have you completed as of today
Do you attend church? If so, where?*
If you do not attend church, just type "No".
We'd love to get to know you! Please share a few highlights of your personal story.*

The Exchanged Life (click to expand)
How do you feel you will benefit from the practicum?*
Describe in your own words The Exchanged Life and share what impact it has had in your life?*
In your own words, explain the believer's identity in Christ.*
What is your understanding of Biblical forgiveness?*
How would you explain the concepts of brokenness and surrender to a counseling client?*
What is your goal in participating in the practicum? How do you anticipate using your practicum training in the future?*

Please mark ALL availability for the practicum (choose at least five). The time slots are in USA Eastern Time Zone. *

If accepted, I agree to pay $1,200:*

$1,200 - Single Payment due prior to practicum start$300 per month (for 4 months) - Monthly payment plan
Let us know if you have any questions or comments.
Please verify that you are human*
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