Certificate LNP Application Contact Information Comments 2017-06-01 GL Reworked the form to identify and document parameters, etc. Changed the certificate dollar amount, start date, and GL Code. Removed scholarship date cut-off calculations. Ideally this should be done BEFORE any applications are created. Any applications created before the amount is updated will need to be manually changed to reflect the new amount.2017-04-07 GL Added conditional to the creation of the feeditem in the SalesForce connector, to make sure that a photo actually exists before trying to load it. Parameters - Update Before Deploying SalesForce Parameters - Probably Do Not Change Calculations - Do Not Change GL Description First Name Middle Name Last Name Maiden/Former Name Preferred Name Email Confirm Email Phone Address City State/Province Zip/Postal Code CountryPlease select... UNITED STATES CANADA AFGHANISTAN ÅLAND ISLANDS ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTARCTICA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA, PLURINATIONAL STATE OF BONAIRE, SAINT EUSTATIUS AND SABA BOSNIA AND HERZEGOVINA BOTSWANA BOUVET ISLAND BRAZIL BRITISH INDIAN OCEAN TERRITORY BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLAND COCOS (KEELING) ISLANDS COLOMBIA COMOROS CONGO COOK ISLANDS COSTA RICA CÔTE D'IVOIRE CROATIA CUBA CURAÇAO CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS (MALVINAS) FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA FRENCH SOUTHERN TERRITORIES GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUERNSEY GUINEA GUINEA-BISSAU GUYANA HAITI HOLY SEE (VATICAN CITY STATE) HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN, ISLAMIC REPUBLIC OF IRAQ IRELAND ISLE OF MAN ISRAEL ITALY JAMAICA JAPAN JERSEY JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA, REPUBLIC OF KUWAIT KYRGYZSTAN LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAO MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA, FEDERATED STATES OF MOLDOVA, REPUBLIC OF MONACO MONGOLIA MONTENEGRO MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PALESTINIAN TERRITORY, OCCUPIED PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN POLAND PORTUGAL PUERTO RICO QATAR RÉUNION ROMANIA RUSSIAN FEDERATION RWANDA SAINT BARTHÉLEMY SAINT KITTS AND NEVIS SAINT LUCIA SAINT MARTIN (FRENCH PART) SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SINT MAARTEN (DUTCH PART) SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SVALBARD AND JAN MAYEN SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN, PROVINCE OF CHINA TAJIKISTAN TANZANIA, UNITED REPUBLIC OF THAILAND TIMOR-LESTE TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM URUGUAY UZBEKISTAN VANUATU VENEZUELA VIET NAM VIRGIN ISLANDS, BRITISH VIRGIN ISLANDS, U.S. WALLIS AND FUTUNA WESTERN SAHARA YEMEN ZAMBIA ZIMBABWE Please upload a photo of yourself. Please limit file size to under 2MBs. Date of Birth Please format as (10/22/1970) GenderPlease select... Female Male Nonconforming Which of the following best describes your relational status?Please select... Single Married/Partnered Divorced Widowed Please describe your ethnic heritage: Authorize.net parameters - Do Not Change Additional Information How and when did you first hear about the Leadership in the New Parish certificate program? Who or what influenced you to apply?Inhabit ConferenceNew Parish bookParish CollectiveSeattle School - FacultySeattle School - AlumniSeattle School - Current StudentTeacher or ProfessorCounselor or TherapistPastor or MinisterFamily or FriendSocial MediaPrint Material or PublicationSeattle School - WebsiteSeattle School - Event or WorkshopVisit to CampusAdmissions RepresentativeAllender CenterThe Other JournalOther Other Influence Do you wish to enroll in this offering for graduate level credit?YesNo Are you currently enrolled as a student at The Seattle School?YesNo What is the highest level of education you have completedPlease select... GED High School Bachelor Master Doctoral School(s) attended Name of school Degree pursued Start date (estimate) Please format as (05/10/1970) End date (estimate) Please format as (09/10/1972) Are you currently enrolled?Yes Did you graduate?YesNo GPAPlease select... 4.0 or higher 3.99-3.5 3.49-3.0 2.99-2.5 Lower than 2.5 I don't remember Which of the following best describes your employment status?Please select... Student Part-time employment Full-time employment Not currently working or attending school What is your current occupation/vocation? What is your denominational affiliation? (if applicable)Please select... NonDenominational Advent Christian Church African Methodist Episcopal African Methodist Episcopal Zion American Baptist Churches in the USA Anglican Church of Canada Assemblies of God Associated Gospel Churches (of Canada) Associate Reformed Presbyterian Church Baptist Convention of Ontario & Quebec Baptist General Conference Baptist Missionary Association of Americ Baptist-Other Baptist Union of Western Canada Brethren Church (Ashland, OH) Brethren in Christ Church Christian and Missionary Alliance Christian Brethren (Plymouth Brethren) Christian Church (Disciples of Christ) Christian Churches & Churches of Christ Christian Methodist Episcopal Christian Reformed Church Churches of Christ Churches of God, General Conference Church of God Church of God (Anderson, IN) Church of God in Christ Church of the Brethren Church of the Nazarene Conf. of Congregational Christian Church Conservative Baptist Assoc. of America Convention of Atlantic Baptist Churches Cumberland Presbyterian Church Episcopal Church, The Evangelical Church in Canada Evangelical Congregational Church Evangelical Covenant Church Evangelical Formosan Church Evangelical Free Church of America Evangelical Lutheran Church in Canada Evangelical Luthern Church in America Evangelical Presbyterian Church Fellow. of Evan. Baptist Church-Canada Foursquare Gospel Church Friends, Religious Society of General Assoc. of Regular Baptist Church General Baptist State Convention, NC Greek Orthodox Archdiocese in N/S Amer Independent Baptist Independent Methodist Jewish Lutheran Church - Canada Lutheran Church - Missouri Synod Lutheran - Other Mennonite, Other Mennonite Brethren Church in North Amer Mennonite Church, Canada Mennonite Church, USA Missionary Church in Canada Moravian Church in America Muslim National Baptist Convention New Jerusalem, General Church of North American Baptist Conference Orthodox, Other Orthodox Church in America Orthodox Presbyterian PCUSA Pentecostal Assemblies of Canada Presbyterian Church in America Presbyterian Church in Canada Progressive National Baptist Convention Protestant Reformed Church in America Reformed Church in Canada Reformed Episcopal Church Reformed Presbyterian Roman Catholic Salvation Army Seventh-day Adventist Seventh Day Baptist General Conference Southern Baptist Convention Swedenborgian Church, General Convention Union d'Eglises Baptistes Francaises-Can Unitarian Universalist United Church of Canada United Church of Christ United Methodist Church Wesleyan Church Wisconsin Evangelical Lutheran Synod None of these fit Denomination Other: Do you have any dietary restrictions or food allergies we should be aware of? Organization What is the name of your parish/church/organization? This is my employer Role/Title Website How long have you been involved? In 3-4 sentences, provide some context about your neighborhood. Briefly describe your engagement in your neighborhood. Provide an example of a regular practice that roots you in your neighborhood. What do you desire/hope for your neighborhood? Briefly describe why you are drawn to the Leadership in the New Parish certificate and how you imagine the mission and ethos of this program will impact you and the presence you bring to your neighborhood. Recommendations & Compliance Please provide two references. We reserve the right to contact the references you provide to inquire about your character and readiness for the program. Reference 1 First Name Last Name Email Relationship Length of Relationship Reference 2 First Name Last Name Email Relationship Length of Relationsip Compliance The Seattle School seeks to set a table for discourse in the intersections of theology, psychology, culture, and spirituality. That means we embrace in our life and work a commitment to racial, ethnic, and gender diversity and an inclusive welcome to communions represented in the global church. Our admissions philosophy is to receive applications without discrimination on the basis of race, ethnicity, religion, gender, age, national origin, disability, marital status, sexual identity, sexual orientation, military status, or denomination. Have you ever been suspended or expelled from an academic institution?YesNo Please provide a brief description of the circumstance(s). Have you ever required psychiatric or psychological treatment?YesNo Please provide a brief description of your treatment. The intent behind this question is to gather information about significant psychiatric or psychological treatment (e.g. recent experience or memory of intense trauma, onset of PTSD, hospitalization, suicide attempts, in-patient rehab). As a community we encourage and honor personal therapeutic work and do not discriminate against individuals who have sought help. If your answer to this question is "yes", we'd like to gain a greater understanding of where you are at in your own process in order to decide together whether or not this program would be safe and honoring for you at this time. Do you have charges pending against you, entered a plea for, or been convicted for a crime other than a minor traffic violation?YesNo Please provide a brief description of the charges and/or crime. Costs & Accessibility We believe the impact of this program on leaders and the communities they serve is well worth the investment. And, we understand that costs may be a barrier. A limited number of grants are available. To express in this funding, please provide additional context below. I'd like to learn more about grant funding. Grant Funding Briefly describe your financial circumstances and how a grant would make this program more accessible. Briefly describe funding resources available to you (e.g. denominational funding, continuing education stipends, etc) I submit that all the information contained in my application is complete and correct. I understand that any falsification of information is grounds for expulsion. Accept Application Fee Fee: promo code apply code Name on card First Name Last Name Credit Card # Security Code Month Please select... 01 02 03 04 05 06 07 08 09 10 11 12 Year Please select... 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 Need assistance with this form?