Faith and Health Ambassador Course Application Faith & Health Ambassador Course Application Once you’ve submitted this form, you’ll receive an email that includes a link to a Recommendation Form that you’ll want to forward to your pastor or a leader of your organization or ministry so he/she can complete it. After reviewing your Application Form and your pastor’s/leader’s Recommendation Form, we’ll make a determination of your acceptance into the FHA Course. Once accepted, you’ll receive payment instructions. IF YOU HAVE DIFFICULTY SUBMITTING THE FORM OR YOU DO NOT RECEIVE AN AUTOMATIC EMAIL AFTERWARDS, PLEASE CONTACT US. Use the Contact Page or call 803-802-3210. Thank you. Name*Your Name First Last Course DateWhich course date do you desire to attend?Sep 8 - Nov 17, 2016Daytime Phone*What is your daytime number?Evening Phone*What is your evening number?Email*All Course-related emails will be sent to this address. Address*Please indicate where you'd like us to send your course materials and your certificate of completion. NOTE TO CANADIAN RESIDENTS: Include your province in the City field. Select Armed Forces Pacific as the State. Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Significant Other/FamilyIf you are married or there is a significant other in your life, please share their name. If children live at home, please share their names and ages.Profession/VocationPlease briefly describe any profession or vocation you may currently be involved in. If employed, your job title.How did you learn?*How did you learn about the Faith and Health Ambassador initiative? (If referred by someone, please add their name in the box below.)The websiteMy pastor/churchNewsletterFacebookTwitterLinkedInReferred by someone (please provide name below)Professional NetworkRadioNewspaperOther (please explain below)Other/Referred ByIf you marked Other, please explain here. If someone referred you, please enter their name here.WebsiteIf you have a personal, business or ministry related to wellness, please share the web address. Fee Payment*Please indicate whether you or your church/organization will be making payment.My church/organization - $247.00Myself - $347.00Discount CodePlease enter your discount codeChurch/Organization/MinistryIndicate the name of the church/organization/ministry where you would likely facilitate a PathWay 2 Wholeness Bible Study.Website of the Church/Organization/MinistryWhat is the web address of the church/organization/ministry? Pastor/LeaderWhat is the name of the pastor or leader from the above church or organization who will endorse your participation in this course? First Last Your Affiliation*Please describe what affiliation you might have with the church/organization/ministry. Are you a member, on staff, volunteer, etc?Interest*Why do you desire to participate in this program?PathWay 2 Wholeness Study*We believe that the greatest impact the FHA intiative will have is by the Ambassadors sharing what they learned with others through the leading of the PathWay 2 Wholeness study. Describe where, when and how you see yourself using the PathWay 2 Wholeness study (that you will be equipped to lead) to disciple others and make a difference for the Kingdom of God.Time Commitment & Availability*Participants are expected to attend at least 9 of the 11 weekly two hour live online tele-seminars/webinars. In addition to these meetings, approximately 2-3 hours of preparation time is required to complete the assigned readings and interact with fellow students on an online interactive forum. Are you able to commit this amount of time?YesNoPreparation*Please describe what experience or education you might have related to the field of health, wellness or the Christian faith that has prepared or equipped you to perform the role of a Faith and Health Ambassador.Statement of Faith*Please briefly describe your statement of faith.Spiritual Maturity*Please briefly describe your level of spiritual maturity.Class-Leading Experience*You'll be encouraged to lead small groups of people (5-20) in PathWay 2 Wholeness studies. Briefly describe what experience you have leading group courses, Bible studies or other educational programs. PowerPoint Experience*The PathWay 2 Wholeness study facilitator material is currently in a Microsoft PowerPoint presentation. Select the one answer that best describes your comfort level using PowerPoint.I have never used PowerPointI am marginally comfortable using PowerPointI have a decent command of PowerPointI can very easily prepare and deliver a PowerPoint presentation.I am a master at PowerPoint. I have taught PowerPoint classes.PLEASE NOTE:If this Application Form is working correctly, once you submit the form you ought to receive an automatic email within a few minutes. If you do not receive an email, please use the Contact Form on the website or send an email to - dale AT faithandhealthconnection DOT orgOther CommentsAre there any other comments you'd like to include with this application? Share with your friends . . . . . .