Request for Certificate in Contemplative Spiritual Formation

Request for Certificate in Contemplative Spiritual Formation
For a certificate to be conferred, this request form must be completed and submitted to the Associate Director of Spirituality and Lifelong Learning. It is recommended that the form be submitted at the same time as your final paper.
Name (as you would like it to appear on your certificate)*
Email Address*
Mailing Address (preferred address to send the certificate)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Title of Practicum*
The Contemplative Spirituality Program intends to send an announcement of your completion to your pastor and judicatory official (Executive Presbyter, District Superintendent, Bishop, or someone you would like to be notified of your graduation). Please provide us with the correct contact information.
Pastor
Name of Church*
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Judicatory Official's Name (please indicate relationship, i.e. Executive Presbyter, District Superintendent, Bishop)
Judicatory Offical's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please allow 2-3 weeks for processing.
Should be Empty: