Admission Request Form - First Responders Chaplain Association

Now taking applications for Winter 2024. Classes start in January 8th. Orientation date December 11, 2023. For more information please call 678-438-2322. Space is limited.

Please provide ALL requested information. This document will become a permanent part of your school records. Any false statements will result in immediate expulsion. All student records are confidential, and the contents of a student record will not be released to any member of the public without the prior written consent of the student.

Name *

First

Last

Email *

Address Line 1 *

Address Line 2

Layout

City *

Postal Code *

State *

Country *

Phone *

Emergency Contact

Name *

First

Last

Phone *

Relationship to applicant *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Gender *

Are you a veteran of the U.S. Military? *

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This application is for enrollment as: *

Chaplain Basic Training
Continuing Education

Chaplain Basic Training: Require 25 hours for certification. Continuing Education: Require 20 hours of continuing education every year for good standing, chaplain.

Which campus do you seek admission? *

Do you hold credential with any other Christian institution? *

If yes explain

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Are you currently or have you ever been charged with or subject to disciplinary action for scholastic or any other type of misconduct at any educational institution? *

Have you ever been charged with a violation of the law which resulted in, or if still pending could result in, probation, community service, a jail sentence, or the revocation or suspension of your driver’s license (including traffic violations which resulted in a fine of $200 or more?) *

High School Information

High School Name *

Graduation Date *

If graduated please enter graduation date, or expected graduation date.

Please provide 2 references. Not Related to you

Name *

First

Last

Phone

Relationship *

Name *

First

Last

Phone *

Relationship *

Extracurricular, Personal and Volunteer Activities

Extracurricular Activities *

List your organizations, position, description of the activity, and hours per week of involvement.

Talents and Awards *

List each, a description, the level, and number of years of involvement.

Community Service Work

List the type of work, your role, and hours per week of involvement.

Employment *

List the job, your title, description, hours per week, and dates of employment.

Attach a resume if available, Word, PDF or text document if necessary

Click or drag files to this area to upload. You can upload up to 3 files.

Please attach a 2 photo ID *

Click or drag files to this area to upload. You can upload up to 5 files.

Agreement

I understand that this application is for admission only for the term indicated. I agree that I am bound by the F.R.C.A. regulations concerning application deadlines and admission requirements. I agree to the release of any transcripts and test scores to this institution, including any SAT, Achievement Test, and ACT score reports. I certify that this information is complete and accurate. I understand that making false or fraudulent statements within this application or residency statement will result in disciplinary action, denial of admission and invalidation of credit or degrees earned. If admitted, I agree to abide by the policies of the Board of Regents and the rules and regulations of the F.R.C.A. Should any information change prior to my entry into the F.R.C.A. I will notify the Office of Admissions. I understand that the application fee I submit with this application is a non-refundable fee.

Do you understand and agree to the terms listed above? *

Yes, I understand and agree to the terms listed above.

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Credit Card Information *

Application Fee

Price: $55.00

Application fee is non refundable.

This application was updated 05/2023

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