Church Name

Church Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Church Denomination

Please list applicants' names (up to three) and each of their church roles.

Please list the highest academic degree (including institution) for each applicant.

Email

Please only list one for the entire group.

Phone

Please only list one for the entire group.

(###)

###

####

What is your current connection to the Center for Pastor Theologians (if any)?

(i.e. previous CPT program participation, CPT resources you have encountered)

Reference Role/Title

Please provide the name of a Senior/Lead Pastor, board chair, supervisor or equivalent leader who is willing to serve as a reference. If one of the applicants is the Senior/Lead Pastor or equivalent, please provide that person's information.

Reference Name

First Name

Last Name

Reference Email

If your application is accepted, are you able to attend the retreat on March 16-17 in Nashville?

We understand that illness or other significant life events may occur, but we ask that cohort members otherwise prioritize the retreat.

Yes

No

If you have any questions about this application, please contact Steve Williamson at swilliamson@pastortheologians.com

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