CAPC Application

Intro Tab
Personal Information
Contact Information
Religious Affiliation
Enrollment Information
Academic History

is required

is Required

Salutation
First Name
Middle Name
Last Name
Preferred Name
Suffix
Primary Email Address
Social Security Number No Dashes (Required for IRS form 1098-T)

Confirm Social Security Number No Dashes (Required for IRS form 1098-T)
Date of Birth
Gender
Are you Hispanic or Latino?
Select one or more of the following races

White

Black or African American

Asian

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander
What country represnts your primary citizenship?
Marital Status
If you are in the United States on a visa, please select your visa

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Home Address
Country
Street 1
Street 2
Street 3
City
State
Zip Code Zip Code Extension
Primary Phone Number Primary Phone Number Area Code Primary Phone Number Exchange Primary Phone Number Number Primary Phone Number Extension Ext:
International Phone Number International Phone Number Extension Ext:
Mailing Address
Copy Home Address Into Mail Address
Mail Country
Mail Street 1
Mail Street 2
Mail City
Mail State
Mail Zip Code Mail Zip Code Extension

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I have read the additional requirements for students needing fieldwork hours.

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What is the highlest level of education you have completed?
Last school attended graduation month
Last school attended graduation year
Missio Seminary’s CAPC program requires an MA in Counseling degree or its equivalent from an accredited institution. Please let us know what graduate school(s) you have attended or are currently attending by clicking in the boxes and selecting the colleges.
Last School Attended

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College Name

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College Name

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Academic program for which you are applying
Anticipated Starting Semester

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What date did you take OR will you be taking the TOEFL?
Highest college degree
If referred, please list name of person or venue.
Maiden Name
If you are a current Missio Seminary MAC student: Address any areas of concern (i.e., academic/character/fieldwork) that were a part of your reviews and evaluations while in the MAC program.
Why were they concerns? What have you done to improve upon these areas? How might these areas affect your success in this Advanced Training and what measures do you have in place to address them?
How did you hear about <School Name>?
Spouse Name
If you are not a current Missio Seminary MAC student: Describe your conversion to Christ.
Your response
How does your acceptance into and successful completion of the Advanced Training fit into your professional development plans and goals for your future?
Click to acknowledge

I acknowledge I have read the guidelines.
I certify that, to the best of my knowledge, all information on this application is true and correct. If I am asked, I agree to give proof that my information is correct, and to do so in a timely manner. I also understand that I must inform the seminary of any violations of any federal, state, county, military or municipal laws or child abuse claims, or dismissals from a church due to a moral or ethical failure, that occur after the date of this application form, including through graduation, if selected for admission into a certificate or degree program. I understand that my application must be accompanied by a nonrefundable $30 fee.

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