Clone of LTF Registration 2024-25

1

Regional Fellowship Location* This field is required.If you are not located in one of these areas, please exit and do not complete this form.

Michigan (Grand Rapids Area)

Massachusetts (Greater Boston Area)

2

Email* This field is required.

example@example.com

3

Name* This field is required.

First Name

Last Name

4

Gender* This field is required.

Male

Female

5

Academic Background* This field is required.Degree(s), Institution(s), etc.

6

Mailing Address* This field is required.

Street Address

Street Address Line 2

City

State

Zip Code

Country

7

Phone Number* This field is required.

Please enter a valid phone number.

8

Church Name & Role* This field is required.Please list your church name and your current role there

9

Why do you want to be involved in a Regional Fellowship?* This field is required.Please provide a little information on why you wish to join a fellowship, and what you hope to/anticipate to gain from joining a fellowship.

0/500

10

Do you have a CPT Fellows connection?If you were recommended for this program by a CPT Fellow, or are connected with a CPT Fellow, please list the Fellows name below.

11

Michigan Fellowship Payment* This field is required.If accepted into the fellowship, a one-year fee of $1000 will apply to all participants, covering the cost of resources, facilitator costs, and the in-person retreat. Fees can be paid through personal funds, church or denominational support, etc. Please indicate your ability to pay a fellows fee if accepted into the program

Yes, I would be able to pay the fellows fee

Yes, I would in part and request a partial (up to 50%) scholarship for the remainder

No, I would be unable to pay the fee

12

Massachusetts Fellowship Payment* This field is required.If accepted into the fellowship, a one-year fee of $50 will apply to all participants, covering the cost of resources. Please acknowledge this fee if accepted into the program.

Yes, I understand a $50 fee would be requested upon acceptance

13

How did you hear about the Center for Pastor Theologians?* This field is required.

14

Information Acknowledgement* This field is required.By filling out this form, I agree to receive communications from the Center for Pastor Theologians. I also understand that I can unsubscribe at any time.

I acknowledge this information

15

Terms:* This field is required.

I commit to completing a survey at the beginning and end of the program.