Mission Leadership Center   Application for Ecclesiastical Healthcare Endorsement
 
 
 

Name
Address

Telephone/Contact Information:
Office      
Office fax
Home      
Home fax
E-mail     

Diocese of
             
 Date of Birth

For which professional organization do you need ecclesiastical endorsement for healthcare ministry? (check one and only one):

Association of Professional Chaplains
Association for Clinical Pastoral Education
American Association of Pastoral Counselors
College of Pastoral Supervision and Psychotherapy
 
In what order of ministry do you function as a chaplain?
Lay? Deacon? Priest? Bishop?
 
You must make your bishop aware of your desire to be endorsed as a healthcare chaplain before submitting this application. Have you done so? When?
You must complete your diocesan sponsored Sexual Misconduct Training before submitting this application. Have you done so? When?
 
Dates ordained (if applicable)
Diaconate    Diocese
Priesthood   Diocese
Name of your current Canonical Bishop:

Diocese
Name of Bishop within whose jurisdiction you minister
(if different from canonical):

Diocese

Present position and comments:
Are you willing to facilitate ministry to members of all faith groups, realizing that this may include worship by Muslim, Jewish, Native American, Buddhist and other faith traditions?
Yes      No
 

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Application Submission

Thank you for taking the time to complete this application.

If you haven't already done so, please print a copy for your records now.

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A Word About Endorsements

The Mission Leadership Center under the direction of the Rev. Margaret Rose facilitates the process of endorsement required for certification by certain professional associations. We work with your local bishop to see this process to its completion. Please fill out the information in each section as requested. You may send it electronically or print it out and fax or mail it to us. If you would like a copy for your records, please print it out before you click on the submit button. You should also send a copy to your bishop and be in contact with him or her during this process. If we can be of assistance please email us.

Terry Foster
Mission Leadership Center
815 Second Avenue
New York, NY 10017
1-800-334-7626, ext. 6068
Fax: (212) 867-1654
tfoster@episcopalchurch.org

If submitted electronically, you will receive a confirmation message from us shortly.

Copyright © 2003 Office of the Bishop Suffragan for Federal Ministries
All rights reserved.
15 June 2009

 
 
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