Communion of Evangelical Episcopal Churches Diocese of Endorsed Chaplains

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1 Communion of Evangelical Episcopal Churches Diocese of Endorsed Chaplains 902 Spring Valley Road, Altamonte Springs, Florida (407) Dear Friend Thank you for contacting us about your intrust in ministry an endorsed chaplain or pastoral councilor with the Communion of Evangelical Episcopal Churches, (CEEC). CEEC CEEC E S C Ecclesiastical Endorsement is commonly required by employers for ministry in specialized settings like the military, health care institutions and counseling practices. Endorsement is also a common requirement for professional certification. The Office of Endorsed Chaplains grants approval for the training and Ecclesiastical Endorsement to serve on the behalf of the CEEC. Chaplaincy and Pastoral Counseling supports the work of the Office and Diocese of Endorsed Chaplains. We have included, in this package, an application for endorsement along with other necessary documents. We look forward to receiving your application. Please consider the requirements of the organization you are seeking endorsement for before you submit the following forms.. Please include a letter indicating the endorsement or approval you are seeking. Let us know if you have any questions. Please note that the approval process takes several weeks from the date we receive your packet. Mail your application, forms and fees to; Office of Endorsed Chaplains 902 Spring Valley Road Altamonte Springs, Florida Our blessings are sent to you as you consider the leading of the Holy Spirit into this specialized work of ministry. Sincerely, Bishop David Scott Chief Endorser for the Communion of Evangelical Episcopal Churches Diocese of Endorsed Chaplains

2 Check endorsement credential(s) for which you are applying: ( ) Army ( ) Active Duty ( ) Navy ( ) Active Duty ( ) Air Force ( ) Active Duty ( ) Military Guard ( ) Military Reserves ( ) Military Seminarian ( ) Civil Air Patrol ( ) Veterans Affairs ( ) Civilian Healthcare ( ) Correctional ( ) Workplace ( ) Public School ( ) Professional Counselor ( ) Certified Volunteer ( ) Other: Application For Ecclesiastical Endorsement, Approval, or Certification For Appointment as Chaplain, or Chaplain Candidate, With The Communion of Evangelical Episcopal Churches In the Diocese of Endorsed Chaplains For Office Use Only Date Received College Transcripts Seminary Transcripts Essays Personal Testimony 2 Recent Photographs Statement of Understanding Code Of Ethics Background Afermation Statement of Authorization CEEC Identity Statement Copy of Ordination References Application Fee Office of Endorsed Chaplains 902 Spring Valley Road, Altamonte Springs, Florids (407) INSTRUCTIONS: Please print or type answers to all questions. If you need more space, please feel free to attach separate sheets. A. Personal Data 1. Name Date of Birth Soc. Sec. No. Last First Middle 2. Address Address 3. Home Address ( ) 4. Office Address ( ) 5. Are you an American citizen? (a) By Birth? (b) By naturalization? Give Date: 6. Height 7. Weight 8. Have you any physical defects? ( ) No ( ) Yes. If so, describe: 9. Do you have any disabilities? If so, briefly describe: 10. Have you ever been hospitalized for mental health concerns? ( ) No ( ) Yes. If so, please state the nature of illness(es): (Use the back or separate sheet of paper if necessary.) 11. Have you ever been charged with or convicted of a criminal offense? ( ) No ( ) Yes. If so, When? Where? Charges: 12. Have you ever committed a serious criminal act for which you were not charged? ( ) No ( ) Yes. Is so, When? What was it? 13. Have you ever filed bankruptcy or had any serious financial problems? ( ) No ( ) Yes. If so, what date? 14. What are your hobbies? 15. Describe athletic ability.

3 B. FAMILY AND MARITAL DATA 1. What is your marital status? If married, date of marriage 2. Spouse s name: 3. Are you and your spouse living together? ( ) Yes ( ) No 4. Do you or your spouse have a former marriage(s) or living companion? ( ) No ( ) Yes Please explain your history on a separate sheet of paper. Note: A divorce is not an automatic disqualifier. 5. To what extent does your spouse share/support your interest in pastoral care giving? 6. If you have children, list name and date of birth of each. Child 1. Name D.O.B. Age ( ) Male ( ) Female Child 2. Name D.O.B. Age ( ) Male ( ) Female Child 3. Name D.O.B. Age ( ) Male ( ) Female Child 4. Name D.O.B. Age ( ) Male ( ) Female 7. List permanent emergency address and telephone number. Address ( ) 8. List Someone other than yourself, who will always know your whereabouts Name First Last Relationship Address ( ) C. References Name First Reference Address, City, State, Zip Telephone & How Long Name Second Reference Address, City, State, Zip Telephone & How Long Name Third Reference Address, City, State, Zip Telephone & How Long

4 D. MINISTERIAL AND SPIRITUAL DATA 1. Date of Salvation: 3. Date Baptized: 2. Have you experienced the Baptism of the Holy Spirit: If so, when, 3. Please indicate your current ministerial status. ( ) Deacon ( ) Priest ( ) Bishop Other: 3. When were you Licensed? By whom? Tel. 4. When were you Ordained? By whom? Tel. 6. When were you Consecrated? By whom? Tel. 7. What is your church background: 8. Are you currently an Endorsed Chaplain? ( ) Yes ( ) No (Name of Endorsing Organization?) Name and Address of Current Endorsing Agent 9. If you are requesting a change from your current endorsing Organization/ Denomination please give a brief reason why. 9. Have you previously applied for approval or endorsement with the CEEC? ( ) Yes ( ) No What disposition was made of this previous application? 10. Full Time Ministerial Experience, Post Seminary, Post Ordination if any, beginning with the present and working back: (Use the back or separate sheet of paper if necessary.) 1. Church or Employer From: To: 2. Church or Employer From: To: 3. Church or Employer From: To: 4. Church or Employer From: To:

5 E. EDUCATIONAL DATA 1. College and Seminary training (please do not use initials for school names): (Use separate sheet of paper if necessary.) Name of College or Seminary Address, City, State, Zip Name of College or Seminary Address, City, State, Zip Name of College or Seminary Address, City, State, Zip Name of College or Seminary Address, City, State, Zip 2. Please send copies of all college and seminary transcripts (as applicable) to the Office of Endorsed Chaplains. 3. Have you had any Clinical Pastoral Education? ( ) Yes ( ) No If so, list be Quarter/Unit (Use the back or separate sheet of paper if necessary.) 4. Have you had any Supervised Pastoral Counseling? ( ) Yes ( ) No If so, list number of hours. (Use the back or separate sheet of paper if necessary.) 5. Other specialized training you have received (or certifications and memberships you hold) to prepare for chaplaincy:

6 F. DISCUSSION 1. Please discuss the following topics on additional paper: a. Why do you desire to serve as a chaplain? Please explain your call. b. How have you prepared, are you preparing, yourself for the chaplaincy? c. List, in order of priority, the major functions of a chaplain. d. Discuss controversial areas confronting the chaplaincy. e. What do you do most effectively as a minister? f. What do you do least effectively as a minister? g. Your concept of financial stewardship. h. Your understanding of pastoral care in a pluralistic setting. 2. Prepare a testimony of yourself (at least 200 words) and attach it to this application. STATEMENT OF UNDERSTANDING AND COMMITMENT: (Please be sure you read this carefully before signing. If you have any questions or concerns, please call.) 1. I understand that I must meet all the requirements for chaplains of the particular military service or civilian institution or chaplaincy membership organization to which I apply. All USA education must be appropriately accredited (regionally, ATS, or TRACCS). Foreign educational institutions will be evaluated on a case-by-case basis. 2. I understand and authorize that, because of the security requirements of the U.S. Armed Forces (military), and other institutions and organizations (civilian), I will be investigated for criminal and character backgrounds. 3. I understand that, if commissioned or appointed as a chaplain, I will be working with chaplains of other denominations and faith groups, sometimes differing widely with my own views and beliefs. While I will not be asked to compromise my own conscience and beliefs, it is essential, by the very nature of chaplaincy, that I consider their ordination and ministry as valid in the U. S. military or civilian institution as is my own. I understand that an attitude or practice of hostility and non-cooperation towards pastoral caregivers and adherents of other faiths will not be tolerated and is grounds for the immediate withdrawal of my endorsement credential. I have read and I agree to abide by the CEEC Identity Statement, Background Afermation and Statement of Authorization. Further, I realize that I must be willing to hold General Protestant worship services as well as those services specifically exercising all my own particular beliefs and practices. 4. I understand that it is a requirement of the Pentagon s Armed Forces Chaplains Board as well as civilian institutions and organizations that the CEEC have the authority to issue and withdraw endorsement credentials. 5. I understand that endorsement is a continuing requirement. Should I prove to be personally or professionally, or by other reason unsuited for the chaplaincy and should CEEC decide that my endorsement should be withdrawn, I agree to abide by its decision. Additionally, I understand that continuing education and professional development are essential for maintaining high quality pastoral caregiving. 6. I understand that CEEC is dependent on the financial support of chaplains, churches, and friends. I agree to regularly help with the expense of this ministry. (Generally, it is expected that professional chaplains will contribute 10% of their chaplaincy income, to support this ministry and, thus, safeguard the future of their ability to be responsibly endorsed.) Signature: Date: Permanent Address (if different than above) Home Address ( )

Communion of Evangelical Episcopal Churches Diocese of Endorsed Chaplains

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