Complete this form online and register for the 2017-2018 Integrative Chaplain Certificate Course at Atrium Health in Charlotte, NC.

In addition to the online form, you must submit two recommendation letters, which are detailed below. If you have questions or need additional information prior to registration, please contact Rev. David Carl by phone at 704-355-3361 or by email at Atrium Health Pastoral Care and Education.

Recommendation Letters

You are responsible for obtaining two recommendation letters. You must have two separate recommendation letters from two different individuals. All letters must recommend you for this course.

1. Administrator's Recommendation Letter
You must submit a letter of recommendation from the administrator who evaluates your pastoral, administrative and/or clerical competence. The administrator must identify him or herself as your current supervisor.

2. Board-Certified Chaplain or Peer Professional Recommendation Letters
You must submit two recommendation letters from another board-certified chaplain or from a peer professional other than a non-certified chaplain (e.g., nurse, doctor, social worker), with whom the candidate has a working relationship. Attach recommendation letters at the end of this form or mail to:

Atrium Health
ATTN: David Carl, Executive Director of Spiritual Care
P.O. Box 32861
Charlotte, NC 28232

Personal Information

Consent

I certify that the information in my application materials is accurate and true.

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