Lay Certificate Application Form

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Personal Information
First Name:
Date of Birth (YYYY-MM-DD)
City, Province:
Postal Code:
Daytime Phone Number:
Cell Phone Number
Person to Notify in Case of Emergency
Daytime Telephone Number:
Cell Phone Number:
Alternate Telephone Number:
Educational Background & Religious Information for Statistical Purposes
Previous Degree(s) if applicable:
Religious Affiliation:
Present Congregation:
Background Information
List some of the ways you have been involved in your church:
List some of the educational events in which you have participated in the last three years:
I am particularly interested in these topics:
What draws you to this program?
What are your learning goals?
How would you describe your theological orientation?
Signed By:
Pick date

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