EDUCATION, TRAINING & SPECIAL INFORMATION

YOUR NAME 

List all schools you have attended after High School beginning with the most recent.

            FROM                 TO                                        SCHOOL                            CITY & DEGREE OR     DATE
           MO/YR             MO/YR                                          NAME                            STATE HRS CREDIT GRADUATED

CLINICAL PASTORAL EDUCATION

                  DATES                                                        PROGRAM NAME                                                          CITY                                      STATE         

           

UNITS/CERTIFICATES EARNED  

MILITARY EXPERIENCE

Previous Military Experience and Present Status if Applicable

ACTIVE DUTY BRANCH                          DATES                                            HIGHEST RANK                            DATE OF RANK  

            

    RESERVE BRANCH                                DATES                                            HIGHEST RANK                            DATE OF RANK

             

LIST SPECIALIZED SKILLS AND TRAINING 

      

SPECIAL INFORMATION

HAVE YOU HAD A DRINK OF AN ALCOHOLIC BEVERAGE WITHIN THE PAST 12 MONTHS?     YES    NO

HAVE YOU BEEN CONVICTED OF A CRIME (OTHER THAN A TRAFFIC VIOLATION)?   YES    NO

HAVE YOU USED ILLEGAL DRUGS?    YES    NO

DO YOU PERSONALLY SPEAK IN TONGUES (GLOSSOLALIA) OR HAVE A PRIVATE PRAYER LANGUAGE?    YES    NO

IF YOU ANSWERED YES TO ANY OF THE QUESTIONS ABOVE, PLEASE EXPLAIN.  

 

INDICATE ANY ADDITIONAL INFORMATION THAT YOU THINK THE CHAPLAIN'S COMMISSION SHOULD KNOW.