Dual Certificate Interfaith Chaplaincy and Spiritual Direction Application

Application: Dual Certificate: Interfaith Chaplaincy and Spiritual Direction

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Thank you for your interest in our Dual Certificate Interfaith Chaplaincy and Spiritual Direction. We encourage your thoughtful and reflective completion of this admissions application. If you need help or have questions, you are welcome to call Admissions at 510-843-1422 or email admissions@chaplaincyinstitute.org.

Application and Intent to Enroll Fees: There is a $150 non-refundable application fee, as well as a $250 Intent to Enroll fee. We presume that the submission of your application indicates a preliminary commitment to enroll if accepted. This fee will be credited towards your tuition payments upon final enrollment. It will be refunded if and only if you are not accepted into the program.

Admissions Interviews: We will contact you within two weeks after we receive and review your completed application. At that point, we will schedule an interview via Zoom.

The Application:
- Section 1 About You - Overview
- Section 2 Spiritual Autobiography
- Section 3 Reference Letters
Full Name

PrefixFirst NameLast Name
Pronouns
E-mail:
Phone Number
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Birthdate (optional)
If accepted, when would you like to begin your coursework, ideally?
Please tell us how you learned about The Chaplaincy Institute
Section 1: About You
Education and Training
High School
Undergraduate Institution Attended (if applicable)
Undergraduate Degree Obtained/Major
Graduate Institution Attended (if applicable)
Graduate Degree/Area of Study
Other Certificates/Trainings with Dates of Completion
Clinical Pastoral Education, if applicable (Number of units, Location, Completion Date)
Please upload a copy of your diploma(s) and/or transcripts. For those without a Bachelor's degree, a separate equivalence applicaiton is required. Please contact us for more information at admissions@chaplaincyinstititute.org

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Educational Goals and Direction
Please tell us your main area of interest in spiritual service. (Check as many as apply.)

Other
If you chose "Other" above, please describe
What other commitments do you currently have in your life? (i.e. work commitments, family obligations, raising children, possible plans for relocation, other academic studies, financial concerns, time, ability?) Describe briefly.
We affirm the legislation in 37 states which "bans the box", but also recognize that incarceration and/or conviction of a felony has an impact on your spiritual journey. Answering this question will not preclude your consideration. Have you ever been charged with a felony? If yes, please be ready to talk more about it in your interview.
Please upload your most recent resume/CV as an outline of your professional experience.
Current Resume/CV

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Section 2: Autobiography
In addition to your essay responses, a creative response expressed through any art form is welcome. There is an area below to add any creative work.
Your Life History and Current Circumstances
Give a brief account of your upbringing and significant relationships and events in your life.
Describe some of your personal experiences with diversity in your life (race, class, gender, sexual orientation, socio-economic, religion, size, (dis)ability, etc.) and how this has had an impact on you.
Have you experienced trauma? [Note: this could be anything from abuse, a life-changing medical event, difficulties in your family of origin, witnessing violence, or anything that has been traumatic for you.] If so, how have you worked with the experience of trauma in your own life and/or in your work with others? Has therapy, counseling or spiritual direction been part of your healing process? What are your self-care practices when trauma gets triggered? Please summarize.
Has addiction been part of your life experience – for yourself, your loved ones, or your family of origin? How have you worked with the experience of addiction in your own life and/or in your work with others? Has treatment, therapy or spiritual direction been part of your healing process? What are your self-care practices when addiction behaviors get triggered? Detail briefly.
Participants in this program must have good emotional support in their lives. What are current sources of emotional support for you?
Do you have any special needs or circumstances that would need to be known or supported in order for you to be successful in this program, beyond what you may have listed above?
What other commitments do you currently have in your life? (i.e. work commitments, family obligations, raising children, possible plans for relocation, other academic studies, financial concerns, time, ability?) Describe briefly.
Your Faith and/or Spirituality
How do you describe yourself in terms of religious affiliation or spiritual identity, in a few words?
This program requires participants to engage in at least one spiritual or religious activity or practice on an ongoing basis. Please describe briefly in 1-2 paragraphs, your spiritual practice, including your involvement with a particular organization, group, congregation, temple, sangha, etc.
What changes or challenges (if any) are you currently experiencing in your spiritual and emotional life?
Your Motivation for Pursuing Interfaith Education
At present, how do you envision using this training in your life?
Please describe any experiences that relate to your motivation to engage in interfaith chaplaincy training. What brought you to this decision?
Spiritual service can include providing emotional, spiritual and practical support for people from all walks of life who are experiencing crises of health, faith, identity, etc. What kinds of people and/or situations would you anticipate having the most difficulty working with and why?
If you are someone from a marginalized population, what kind of support would you find helpful in order to participate fully in this program?
Spiritual Direction Program Essays

to supplement the Chaplaincy Program application
If you have an experience of spirtual direction, please describe. If not, program participants are required to have three sessions before beginning the program.
What brings you to this? Please explore your sense of call.
In what context do you see yourself working in Spiritual Direction (i.e. private practice, retreat work, group supervision, etc.)?
At ChI we understand art and creative impulses to be connected and integral to personal revelation, spiritual, and social transformation. You are welcome and encouraged to attach examples of your creativity, as you wish (which will not be returned -- send copies only!).
Please upload any creative examples you wish (optional)

Creative Examples Upload
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Recommendation Letters
Three (3) recommendation letters are required from individuals who are familiar with your spiritual, professional, and/or academic background.

Please send your recommenders this link https://form.jotform.com/chioffice/ChaplaincyProgRecommendation

Please inform them that your application will not be reviewed until their letters are received.

All information received will be kept confidential. Please note that by submitting recommendation letters, you agree to give The Chaplaincy Institute permission to contact your references for any further clarification needed.
Please tell us who to expect Letters of Recommendation from:
I affirm that the information I have provided is true and accurate to the best of my knowledge.
Payment

Application Fee and Enrollment Fee Payment

Dual Program Application Fee

$150.00

Dual Program Intent to Enroll Fee

Will be applied as a credit to your tuition

$250.00

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Application: Dual Certificate: Interfaith Chaplaincy and Spiritual Direction

Section 1: About You

Education and Training

Educational Goals and Direction

Section 2: Autobiography

Your Life History and Current Circumstances

Your Faith and/or Spirituality

Your Motivation for Pursuing Interfaith Education

Spiritual Direction Program Essays

Recommendation Letters

Payment

Application Fee and Enrollment Fee Payment*

Application Fee and Enrollment Fee Payment