Description Welcome to the International Association of Christian Care Professionals (IACCP) membership application. Please complete each section. You may save your progress and return later. For questions, email ihowarth@vision.edu
Address
City
State
Zip Code
Gender
Date of Birth
Marital Status ( Single, Married, Widowed, Divorced, Other)
Anniversary
Spouse’s Name
Business Phone
Home Phone
Mobile Phone
Email
Website (if you have one)
Are you an ordained minister? (Yes/No)
Ordaining Institution and Address
Do you desire to be ordained? (Yes/No)
Education Level
High School
Technical School or College
Graduate School
Degrees/Diplomas
Certifications/Licenses
Section 3: Experience & Affiliations
Denominational/Movement Affiliations
Present Home Church
Time in Current Ministry
Current Ministry Name
Current Position(s)
Past Positions
Other Professional Qualifications
Area of Care Ministry: Counseling, Addictions, Chaplaincy, Coaching, Peer Support, Other
Languages Spoken/Read/Written
Ever Convicted of a Crime? (Yes/No)
(Add conditional paragraph field: “If yes, explain.”)
Only PDF, DOC, DOCX formats
Your Resume or CV
Transcripts
A Photo
Pay Membership Fee on Renewals
Select Membership Level (Multiple Choice):
Level 1 – Clinical Associate ($49)
Level 2 – Clinical Professional ($99)
Level 3 – Clinical Fellow ($129)
Level 4 – Clinical Fellow ($149)
Please give 3 Ministry References.
References 1 - 3
Name
Phone
Relationship
Years Known
Type Your Name as Signature & Date
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