Pronouns *
Email *
Phone *
Employer #1 Name *
Job Title *
Work Phone *
Work Email *
Work Website / URL *
Employer #2 Name
Job Title
Work Phone
Work Email
Work Website / URL
If yes, what changed? *
If not, please indicate why: *
Please include an explanation for each incident or action that caused you to answer “yes.” Please include the date, nature, and place of each incident; where and when each was adjudicated; or the disposition. Indicate steps taken toward resolution, if any. *
If so, please indicate when: *
If not, please indicate your plans for attending a gathering in the next year: *
If not, please indicate your plans for attending the required 6 units clinical of professional ethics CEU’s:
In an effort to understand insurance needs, we are asking chaplains and pastoral counselors to let us know if you or your employer provide liability insurance for your work as chaplains and pastoral counselors. Please let us know who is providing the insurance, either yourself or your employer. *
What professional bodies are you certified and/or licensed with? *
1. Share about your continuing education and/or professional development from the past year, and how any learning has contributed to new understanding, new growth, and/or new practice in your ministry. *
2. Share one or more examples from your work in the past year that affirms your ongoing call to ministry. *
3. In what ways are you caring for yourself in your ministry? *
4. What is the community of faith in which you are currently involved? How is this faith community actively nurturing, supporting, and challenging your spiritual life as well as your ministry? If your faith community is not offering such nurture, support, and challenge, where do you find such engagement with your spiritual life? *
5. Chaplains, pastoral counselors and chaplain educators alike have a common commitment to awareness of how aspects of our identities shape our experiences in the world, including our ability to learn and grow, experience well-being and take action centered on justice. Alongside our continued focus on increasing justice for women and LGBTQIA+ folx, the Alliance of Baptists is working to deepen both our understanding of and commitment to racial justice. Briefly describe your continued work in your own journey with your racial identity. Discuss how this work shapes your work for racial justice, with care recipients, within the workplace and/or congregation. Discuss an instance in the past year in which you used your voice to address racial injustice. *
6. Please share any news of professional and personal accomplishments, concerns, and celebrations as well as those of your loved ones so that the Alliance may pray with and for you. *
7. Are there ways you would like to connect with the Alliance as a whole or with other clergy? How do you picture that connection happening? *
If you responded "Mixed Heritage" or "Other," please describe here:
If you responded "Other" above, please describe here:
If you responded "Other" above, please describe here:
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