Online Application

[uacf7_step_start CSC_Application_1 "Begin Electronic Application"]
Which endorsement credential(s) are you are applying for? Please check all that apply.
ArmyNavyAir ForceMilitary Active DutyMilitary GuardMilitary ReserveMilitary SeminarianCivil Air PatrolVeterans AffairsCivilian HealthcareCorrectionalWorkplacePublic SchoolProfessional Pastoral CounselorCertified VolunteerOther
[conditional endorsement-other][/conditional]
[uacf7_step_end]

[uacf7_step_start CSC_Application_2 "Personal Data"]
[uacf7-row][uacf7-col col:4] 1. Last Name
[/uacf7-col][uacf7-col col:4] First Name
[/uacf7-col][uacf7-col col:4] Middle Name
[/uacf7-col]
[/uacf7-row]

[uacf7-row][uacf7-col 33.333%] 2. Date of Birth
[/uacf7-col]
[uacf7-col 33.333%] SSN
[/uacf7-col][/uacf7-row]

[uacf7-row][uacf7-col 66.666%] 3. Home Address

[/uacf7-col][/uacf7-row]

[uacf7-row][uacf7-col 34%]
City
[/uacf7-col]
[uacf7-col 15%]
State
[/uacf7-col]
[uacf7-col 15%]
Zip Code
[/uacf7-col][/uacf7-row]
[uacf7-row][uacf7-col 33.333%] Home Telephone
[/uacf7-col]
[uacf7-col 33.333%] Email Address
[/uacf7-col][/uacf7-row]

[uacf7-row][uacf7-col 66.666%] 4. Office Address

[/uacf7-col][/uacf7-row]
[uacf7-row][uacf7-col 34%]
City
[/uacf7-col]
[uacf7-col 15%]
State
[/uacf7-col]
[uacf7-col 15%]
Zip Code
[/uacf7-col][/uacf7-row]
[uacf7-row][uacf7-col 33.333%] Office Telephone
[/uacf7-col][uacf7-col 33.333%] Email Address
[/uacf7-col][/uacf7-row]

5. Are you an American Citizen?
YesNo
[conditional citizenship-method]
By birthBy Naturalization[/conditional]
[conditional citizenship-date-wrap]Naturalization date:

[/conditional]
*Items 6 - 9 For Military Applicants Only - all others will skip to #10
Are you a military applicant?
YesNo
[conditional military-applicants]
6. Height

7. Weight
lbs
8. Have you any physical defects?
YesNo
[conditional physical-defects-description]
Briefly describe:

[/conditional]
9. Do you have any disabilities?
YesNo
[conditional disabilities-description]
Briefly describe:

[/conditional]
[/conditional]
10. Have you ever been hospitalized for mental health concerns?
YesNo
[conditional mentalhealth-description]
Briefly describe:

[/conditional]
11. Have you ever been charged with or convicted of a criminal offense?
YesNo
[conditional criminal-offense-description]
[uacf7-row][uacf7-col 20%] When?
[/uacf7-col]
[uacf7-col 50%] Where?
[/uacf7-col][/uacf7-row]
What were the charges?

[/conditional]
12. Have you ever committed a serious criminal act for which you were not charged?
YesNo
[conditional criminal-notcharged-description]
[uacf7-row][uacf7-col 20%] When?
[/uacf7-col][/uacf7-row]
What was it?

[/conditional]
13. Have you ever filed bankruptcy or had any serious financial problems?
YesNo
[conditional bankruptcy-description]
What date?

[/conditional]
14. What are your hobbies?

15. Describe your athletic ability:

[uacf7_step_end]

[uacf7_step_start CSC_Application_3 "Family & Marital Data"]
1. Marital Status:
MarriedSingleEngagedSeparatedDivorced
[conditional marital-status-married]
[uacf7-row][uacf7-col 20%] Date of marriage:
[/uacf7-col]
[uacf7-col 46.666%] Spouse's name:
[/uacf7-col][/uacf7-row]
Are you and your spouse living together?
YesNo
To what extent does your spouse share/support your interest in pastoral caregiving?

[/conditional]
2. Do you have a former living companion?
YesNo
[conditional living-companion-yes]
Please explain your history. [Note: A divorce is not an automatic disqualifier]

[/conditional]
3. Do you have children?
YesNo
[conditional children-yes]
list name and date of birth of each

[/conditional]
4. List permanent emergency contact:
(Someone other than yourself or your spouse, who will always know your whereabouts)

[uacf7_step_end]
[uacf7_step_start CSC_Application_4 "Ministerial & Spiritual Data"]
[uacf7-row][uacf7-col 33.333%] 1. Date of Salvation
[/uacf7-col]
[uacf7-col 33.333%] 2. Date filled with the Holy Spirit
[/uacf7-col][/uacf7-row]
[uacf7-row][uacf7-col 33.333%]
3. When were you licensed?
[/uacf7-col]
[uacf7-col 33.333%] By whom?
[/uacf7-col][/uacf7-row]
[uacf7-row][uacf7-col 33.333%]
4. When were you ordained?
[/uacf7-col]
[uacf7-col 33.333%] By whom?
[/uacf7-col][/uacf7-row]
[uacf7-row][uacf7-col 66.666%]
5. Local church affiliation
[/uacf7-col][/uacf7-row]
6. Have you previously applied for approval or endorsement?
YesNO
[conditional previous-application]
[uacf7-row][uacf7-col 66.666%]
With whom?
[/uacf7-col][/uacf7-row]
[uacf7-row][uacf7-col 66.666%]
What disposition was made of this previous application?
[/uacf7-col][/uacf7-row]
[/conditional]
7. Ministerial experience, beginning with the present and working back:
[uarepeater ministerial-experience-repeater add "+ Add Another Ministerial Experience" remove "Remove"]
[uacf7-row][uacf7-col 50%]
Church or Employer
Position Held
[/uacf7-col]
[uacf7-col 50%]
Address
[/uacf7-col][/uacf7-row]
[uacf7-row]
[uacf7-col 25%] From date: [/uacf7-col]
[uacf7-col 25%] To date: [/uacf7-col][/uacf7-row]
[/uarepeater]
[uacf7_step_end]
[uacf7_step_start CSC_Application_5 "Educational Data"]
1. College and Seminary training, beginning with the most recent and working back:
[uarepeater college-repeater add "Add Another School" remove "Remove"]
[uacf7-row][uacf7-col col:6] Name of College/Seminary

[uacf7-row][uacf7-col 50%] From date:
[/uacf7-col]
[uacf7-col 50%] To date:
[/uacf7-col][/uacf7-row][/uacf7-col]
[uacf7-col col:6] Address of College/Seminary

[/uacf7-col][/uacf7-row]
[uacf7-row][uacf7-col 25%] Major
[/uacf7-col]
[uacf7-col 13%] Total Hours
[/uacf7-col]
[uacf7-col 40%] Degrees Conferred
[/uacf7-col]
[uacf7-col 22%] Transcript (.pdf)
[/uacf7-col][/uacf7-row]
[/uarepeater]
2. Have you had any clinical pastoral education/training?
YesNo
[conditional clinical-training-description]
[uacf7-row][uacf7-col 25%] How many units?
[/uacf7-col]
[uacf7-col 75%] Where did you receive this clinical pastoral training?
[/uacf7-col][/uacf7-row]
[/conditional]
3. Other training, certifications, and memberships you have to prepare for chaplaincy:

[uacf7_step_end]
[uacf7_step_start CSC_Application_6 "Secular Occupational Data"]
1. Occupational experience (list most recent employers):
[uarepeater secular-experience-repeater add "+ Add Another Occupational Experience" remove "Remove"]
[uacf7-row][uacf7-col 50%]
Employer
Position Held
[/uacf7-col]
[uacf7-col 50%]
Address
[/uacf7-col][/uacf7-row]
[uacf7-row]
[uacf7-col 25%] From date: [/uacf7-col]
[uacf7-col 25%] To date: [/uacf7-col][/uacf7-row]
[/uarepeater]
[uacf7_step_end]
[uacf7_step_start CSC_Application_7 "Military Data"]
Do you have prior military service?
YesNo
[conditional prior-service-no] Please click the "Next" button below to continue your application. [/conditional]
[conditional prior-service-yes]
[uarepeater prior-service-repeater add "Add Another Prior Service" remove "Remove"]
1. Previous Military Service:
[uacf7-row][uacf7-col 33.333%] Branch of Service —Please choose an option—Air ForceAir Force ReserveAir National GuardArmyArmy National GuardArmy ReserveCoast GuardCoast Guard ReserveMarine CorpsMarine Corps ReserveNavyNavy ReserveSpace Force [/uacf7-col]
[uacf7-col 40.333%] Service Dates to [/uacf7-col]
[uacf7-col 25.333%] Grade —Please choose an option—EWO - —Please choose an option—12345678910 [/uacf7-col][/uacf7-row]
[/uarepeater]
2. If discharged, type of discharge you received:

Note: If discharged, you must upload a copy of your discharge [DD Form 214] to the CSC:

[/conditional]