CPM Volunteer Chaplain Certification
Fill out the form carefully for registration
Select Certification Class (Cash or Money Order only)
Please Select
Volunteer Chaplaincy Certification($45 Course Fee plus Notebook $20, plus Breaking In To Prison Book $15, $55 UPCI License Fee)
Volunteer Chaplaincy Certification ($45 Course Fee, Email Notebook-Free, plus Breaking In Prison Book $15, $55 UPCI License Fee)
Volunteer Chaplaincy Certification ($45 Course Fee, Email Notebook-Free, Already have Breaking In Prison Book, $55 UPCI License Fee)
Gender
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Male
Female
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Student Name
First Name
Middle Name
Last Name
Phone Number
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Area Code
Phone Number
Student E-mail
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you a licensed minister with the UPCI?
Yes
No
What ministry license do you hold?
Local
General
Ordained
Do not hold a ministry license
Have you been baptized in water by immersion in the name of Jesus Christ for the remissions of sins according to Acts 2:38?
Yes
No
Do you believe that speaking with other tongues as the Spirit gives utterance is the initial sign of the baptism of the Holy Ghost, as according to Acts 2:4?
Yes
No
Have you received this experience?
Yes
No
Church Name
Pastor's Name
Pastor's Phone Number
Pastor's Email
Church Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you been a member of this church?
Register Class
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