Application Entry

Thanks for being interested in becoming one of Athens Church's recommended counselors!

Below is the application to be considered for being included on our list of recommended counselors. Filling out the applcation does not guarantee inclusion on the recommended counselors list. The information you provide below is for internal use only and will not be shared publicly.

Once submitted, someone from our staff will review your application and follow up with any questions or clarifications as part of the process. If your application is approved, we will then provide a form to fill out for the public information that will be listed on on our website.

If you have any questions as part of the application process, please reach out to us at [email protected].

Personal Information

First Name

Last Name

Email Address

Phone Number

Sex

Title

Degree

License Number

Professional Agency Name

Professional Information

Please give a brief overview of your professional experiences, including places, dates, and scope of activities.

Alternatively, you can upload your résumé.

Upload

Please list all professional organizations are you currently affliated with.

Are you currently licensed in your state?

Yes No

Do you have any other certifications that you have not listed above?

Yes No

Please list education background, starting with the most recent.

	School	Dates Attended	Degree
No Items Found

School

Dates Attended

Degree

No Items Found

Do you carry liability or malpractice insurance?

Yes No

Is your liability or malpractice insurance current?

Yes No

Have you ever had a malpractice claim?

Yes No

What is your session cost?

Do you have a sliding scale available?

Yes No

Do you offer financial assistance?

Yes No

Do you accept insurance?

Yes No

Counseling Theory Information

What is your theoretical basis for counseling? Please be specific.

Do you integrate theological with psychological in counseling?

Yes No

Do you use prayer/Scripture in counseling?

Yes No

How do you see church fitting into the counseling process?

Spiritual Information

What is your definition of a Christian?

By your definition, are you a Christian?

Yes No

How would you describe your relationship with Jesus Christ?

What is your basic view on Scripture?

What is your view of God in the healing process?

How do you determine when a client is ready to terminate or graduate from counseling?

What Christian leader or author has most influenced you?

What causes change and growth in counseling?

Do you attend or are you involved with a local church?

Yes No

Do you have any way to have regular "accountability" of your work and ministry?

Yes No

References

Please provide the names/contact information of two professional references who are familiar with your counseling work.

Reference #1

First Name

Last Name

Email Address

Phone Number

Reference #2

First Name

Last Name

Email Address

Phone Number

Submit Application

Counselor Application

Application Entry

Thanks for being interested in becoming one of Athens Church's recommended counselors!

Personal Information

Professional Information

Counseling Theory Information

Spiritual Information

References

Reference #1

Reference #2

10 huntington road / athens, ga 30606
Sundays at 9:15am and 11:00am

Counselor Application

Application Entry

Thanks for being interested in becoming one of Athens Church's recommended counselors!

Personal Information

Professional Information

Counseling Theory Information

Spiritual Information

References

Reference #1

Reference #2

10 huntington road / athens, ga 30606Sundays at 9:15am and 11:00am

10 huntington road / athens, ga 30606
Sundays at 9:15am and 11:00am