Application for New Lay Chaplains Name: (as you would like on your certificate of registration) (required)* First Last Date of appointment: (i.e. Board or congregational vote) Date Format: MM slash DD slash YYYY Canadian Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email (required)* PhoneCongregationYour Congregation’s Contact Person/Lay Chaplain Supervisor: First Last Their phone number and/or email:Congregational experience (e.g. committees, speaking, etc.):Please tell us when and where you took the “Lay Chaplain Basic Training – Designing and Leading Rites of Passage,” and the name(s) of the trainer(s).Denominational (regional, national, continental) experience:Related work or volunteer experience:How do you feel this will be a spiritually deepening experience for you?How do you see the role of lay chaplain in outreach for our religion?Please add anything else you would like to tell the CUC Lay Chaplaincy Committee.Email List The CUC automatically adds you to your lay chaplain region’s email list. If you don’t want to be added, please uncheck box.