Accelerated Application – Direct to Phase 2 Application – Accelerated Application (Phase 2) Step 1 of 4 25% Personal InformationFull Name(Required) Firstname Lastname Sex(Required) Male Female Date of Birth(Required) MM slash DD slash YYYY Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email(Required) US Citizen?(Required) Yes No How long have you lived at your current residence?(Required)Married?(Required) Yes No Name of SpouseAnniversary MM slash DD slash YYYY Do you have any children?(Required) Yes No Have you ever been divorced?(Required) Yes No List date of divorce finalization(Required) MM slash DD slash YYYY Explain circumstances [Essay Box](Required)Was your divorce supported by your church’s leadership and biblical grounds(Required) Yes No EducationCollege NameMajor/DegreeGraduation YearDo you have or are pursuing a Theological degree? Yes No Seminary NameMajor/DegreeGraduation Year or Expected Graduation YearOther education, agencies, or organizations from which you have received trainings, certifications, or licenses. Church InformationAre you an ordained minister?(Required) Yes No What denomination/body?(Required)Ordination CertificateMax. file size: 50 MB. Name of Ordaining church, including city/state location Ordaining Church City State / Province / Region AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date of Ordination MM slash DD slash YYYY List any and all ministry experience, including role, dates, and locations of ministry experienceName of Church where your membership currently resides(Required)Is your home church an IRBC Partner Ministry?(Required) No, I’m seeking certification on my own Yes, my home church is an IRBC Partner Ministry Home Church – Ministry PartnerBethany URC (Wyoming, MI)Bethel URC (Jenison, MI)Central Avenue CRC (Holland, MI)Christ Reformed Church (Sioux Falls, SD)Christian Reformed Church (Volga, SD)Cornerstone URC (Hudsonville, MI)Cornerstone URC (Sanborn, IA)Covenant Grace Reformed Church (Lynden, WA)Covenant Presbyterian Church (Holland, MI)Covenant URC (Kalamazoo, MI)Covenant URC (Pantego, NC)Covenant URC–Byron Center (Byron Center, MI)Doon United Reformed Church (Doon, IA)Drenthe CRC (Zeeland, MI)Dutton United Reformed Church (Caledonia, MI)Eastmanville United Reformed Church (Coopersville, MI)Faith Protestant Reformed Church (Jenison, MI)Faith URC (West Olive, MI)First Protestant Reformed Church (Grand Rapids, MI)First United Reformed Church (Chino, CA)Georgetown Protestant Reformed Church (Hudsonville, MI)Grace Immanuel Ref. Baptist Church (Grand Rapids, MI)Grace Protestant Reformed Church (Grand Rapids, MI)Grace United Reformed Church (Waupun, WI)Grace URC (Alto, MI)Heritage Reformed Congregation (Grand Rapids, MI)Hope Protestant Reformed Church (Redlands, CA)Hudson Valley United Ref. Church (New Hampton, NY)Hudsonville Protestant Reformed Church (Hudsonville, MI)Immanuel Fellowship Church (Kalamazoo, MI)Little Farms Chapel (Coopersville, MI)Loveland Protestant Reformed Church (Loveland, CO)Lynden Protestant Reformed Church (Lynden, WA)Lynwood United Reformed Church (Lansing, IL)Messiah's Independent Reformed (Holland, MI)North Street CRC (Zeeland, MI)Ontario United Reformed Church (Ontario, CA)Pompton Plains Reformed Bible Church (Pompton Plains, NJ)Providence Protestant Reformed Church (Hudsonville, MI)Redeemer Presbyterian Church (Holland, MI)Redeemer URC (Orange City, IA)Rusk Christian Reformed Church (Allendale, MI)Sioux Center URC (Sioux Center, IA)Trinity Reformed Church (Cape Coral, FL)Trinity URC (Caledonia, MI)Unity Protestant Reformed Church (Grandville, MI)Walker United Reformed Church (Grand Rapids, MI)Zion Protestant Reformed Church (Jenison, MI)Denomination or Federation of Church(Required)Address(Required) Church Address State Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Church Phone(Required)Church Website(Required) Name(Required) Pastor’s First Name Pastor’s Last Name Pastor’s or Elder's Email (Other than yourself)(Required) Someone at the church who has spiritual authority over you and your ministry. TheologyDo you subscribe to one of the following doctrinal statements(Required) Three Forms of Unity Westminster Confession of Faith 2nd London Baptist Confession 1689 Is your church's confessional statement one of the following doctrinal statements?(Required) Three Forms of Unity Westminster Confession of Faith 2nd London Baptist Confession 1689 Non-1689 Baptist Confession FormMax. file size: 50 MB. If you are a member of a Baptist congregation in which your church’s leadership (elders) would affirm 2nd London Baptist Confession 1689 but that document is not the official confession of your congregation, you can check 2nd London Baptist Confession 1689 after having your elders fill out our non-1689 Baptist Churches Form (email Admin@reformedcounseling.org for form). Then, upload above.Download Non-1689 Baptist Confession FormDisclaimer and Informed ConsentConsent(Required) I agree to the privacy policy.I hereby affirm that the knowledge contained in this application is correct to the best of my knowledge. I understand and agree that any intentional misrepresentation within this application is sufficient cause for the immediate end of my progress in this certification process and/or the removal of my certification from the Institute for Reformed Biblical Counselors in the future. I authorize any references provided to the Institute for Reformed Biblical Counseling through this website to give information (including personal options) that they may have concerning my life, character, and fitness for certification. I hereby release all individuals, references or persons or organizations from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs, or my family on account of compliance or any attempts to comply with the release of information process. I recognize that it is an incredible privilege to serve as a certified counselor with the Institute for Reformed Biblical Counseling. Therefore, I humbly accept that the Institute for Reformed Biblical Counseling may need to revoke my certification and/or involvement in the certification process if evidence presents itself that I am no longer living according to the Institute for Reformed Biblical Counseling’s doctrinal statement, code of conduct, and/or in a manner consistent with a follower of Christ. In this way, I grant the Institute for Reformed Biblical Counseling and/or my church’s present leadership the right to revoke my certification and/or application for certification without reason, warning, or refund of expenses and charges. Digital Signature(Required)Full Name(Required)This field is hidden when viewing the formDate MM slash DD slash YYYY Password Enter Password Confirm Password Create a password for logging into this site. Unique ID
