Fall 2012 Professional Practitioner Studies Program Application

Fall 2012
Professional Practitioner Studies Program
Application
Professional Practitioner Studies Program
Application Instructions
1. Refer to Practitioner Education Program catalog course prerequisites on
page 8 to verify you have completed required coursework. Any questions,
please call Education Registrar at (720) 974-2242.
2. Read and sign Mile Hi Church Training and Licensing Process letter
3. Complete Application. Internet Users: If you download a copy from our
website the forms can be filled in but you cannot save a copy. Remember
to print copies of the forms; one to submit with your paperwork to the Core
Education Registrar and one for your records.
4. Non-refundable $30 application fee
5. Recent photo attached to application
6. Signed Background Screening Consent Waiver
7. Complete History of Certificated Classes
a. Classes taken in other spiritual communities will require either
copies of certificates or transcript from the community the
corresponding class was taken.
Note: It is important that all information be accurate as it will be used
and verified by Centers for Spiritual Living (CSL) for your practitioner
license.
8. Complete Workshop Prerequisite History
9. Submit completed application packet by mail or in person to the church
administrative office.
Mile Hi Church
Attn: Education Registrar
9077 W. Alameda Avenue
Lakewood, CO 80226
Note: Application deadline: August 30th,, 2011.
No applications will be processed after August 30th.
Any questions, please contact Education Registrar at (720) 974-2242
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May 1, 2011
Re: Mile Hi Church Practitioner Training and Licensing Process
Dear Practitioner I Students,
We offer our heartfelt congratulations on pursuing the path of studies that can lead you to
licensing by our parent organization, the Centers for Spiritual Living. The curriculum that we
teach each week is provided to us by CSL and is the baseline for what is required to pass the
Professional Practitioner Studies Program at Mile Hi Church.
Over the two year program each student must complete Facilitator Training, a total of 6 Voice
Dialogue sessions, 6 different Practitioner sessions and one of Dr. Roger’s Meditation
Retreats. These requirements, along with the course curriculum, are intended to prepare you
to pass both your written and your oral exam in your final year of Professional Studies. If you
have any questions about your class requirements, please contact the registrar at
(720) 974-2242 or consult the Practitioner Professional Studies course catalog.
Although, the majority of practitioner students do pass the licensing exam process, not all
students have passed and become licensed Practitioners. The preparation we offer is not a
guarantee that you will pass the written or oral exam. It is important to note that the work of
preparation must go beyond just an intellectual understanding of the Science of Mind and
Spirit principles and must include a corresponding heart application of these teachings. Your
ability to incorporate SOMAS in your heart and mind could be assessed in either your final
written or oral exam. In some cases a postponement may occur and a minimum of a one
year delay in licensing could take place. It is important to clear any issues that could be a
block to being fully in service to Mile Hi Church or the church that will hold your license. It is
important to be heart connected with SOMAS principles to become a practicing practitioner.
Unhealed areas have a way of showing up in either of the licensing exams. The Oral Exam
will be given in the presence of a licensed minister and 2 licensed practitioners.
We want to be clear on the licensing requirements with all practitioner students as you enter
and continue your preparation studies. We would appreciate it if you would please sign this
letter as indication that this communication has been received.
Thank you and Blessings on your Continued Path,
Dr. Patty and Rev. Ras
_________________________________________________
Student Name
Date
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Mile Hi Church
Professional Practitioner Studies Program
Practitioner I Application
(Please type or legibly print all information)
Name:____________________________________________________________
Social Security Number:____________-_____________-_____________
Address:__________________________________________________________
Home Phone:_________________________ Work Phone: _________________
Other Phone:_________________________ Fax :________________________
E-Mail Address:____________________________________________________
Date of Membership to Mile Hi Church:__________________________________
(Membership required 18 months before completing Prac II)
What activities have you participated in at Mile Hi Church?
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
What other Religious Science Churches/Centers have you previously attended?
_________________________________________________________________
_________________________________________________________________
What activities did you participate in at your previous church?
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
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Educational Background
Institution
Dates of Attendance
Degree/Certificate
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
List activities, such as hobbies you enjoy, civic or professional involvement:
_________________________________________________________________
_________________________________________________________________
List any training programs that you have taken that you feel are part of your
preparation for spiritual leadership (include dates):
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
The following are the basic requirements for entrance into the Professional
Practitioner Studies Program. Please use a separate sheet of paper, include the
number of the statement, and write a brief statement of how this applies in your
life.
1. Demonstrating Universal Principles as taught in SOM is of primary
importance in my life.
2. I am emotionally and socially mature in all of my personal and professional
relationships.
3. I think and act independently. I take initiative and take responsibility for my
own actions in both problem-solving and goal accomplishment.
4. I have a love of learning and self-knowledge. I am open to suggestions and
avenues for change in my life.
5. I am financially secure and responsible.
6. I maintain a professional attitude, which exemplifies the high standards of
the call to spiritual service, through my personal appearance, integrity and
ethical judgment.
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Statement of Purpose
Please use a separate sheet of paper to discuss the following questions. Respond
openly and honestly to each question.
1. Discuss the primary reasons for your desire to become a Religious Science
Practitioner.
2. Discuss your attributes and liabilities in pursuing this path? What kinds of
things do you do particularly well? What are areas that need
strengthening? What are your limitations? Do you have time and energy to
devote the Practitioner Studies?
3. Discuss how your life experiences have shaped you for your call to
Practitioner Studies?
I have successfully completed the prerequisite courses and workshops as outlined
in Page 8 of the Practitioner Professional Studies Program Catalog.
I understand that being accepted into the Professional Practitioner Studies
Program does not in any manner suggest that I will automatically be accepted into
Practitioner II.
I must successfully pass Practitioner I and the Practitioner II continuation
interview.
I further understand that all class tuition and other fees must be paid in full as
outlined in the course catalog.
I understand that my acceptance into the program means I am expected to honor
the professional and ethical standards of the Practitioner Code.
NOTE: An appointment will be scheduled for your Admissions Panel Group
Orientation after your application is reviewed.
Applicant Signature________________________________ Date___________
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Professional Practitioner Studies Program
Mile Hi Church
Background Screening Consent
Applicant should complete all relevant information and sign and date the form.
I,___________________________________, hereby authorize MILE HI CHURCH
and/or its agents to make an independent investigation of my background, past
employment, education, adult criminal or police records including those maintained
by both public and private organizations and all public records for the purpose of
confirming the information contained on my Application and/or obtaining other
information which may be material to my qualifications for my entry into
Practitioner Studies at Mile Hi Church.
I release MILE HI CHURCH and its agents and any person or entity, which
provides information pursuant to this authorization, from any and all liabilities,
claims or law suits in regards to the information obtained from any and all of the
above referenced sources used. The following is my true and complete legal
name and all information is true and correct to the best of my knowledge:
Full Name (printed) ________________________________________________
Maiden Name or Other Names Used __________________________________
Social Security Number
__________ - __________ - ____________
Date of Birth ____________ / ____________ / ____________
Present Address __________________________________________________
City ______________________________ State ___________ Zip __________
How long at former address? ________________________________________
Please list all states of residence since turning age 18: ____________________
________________________________________________________________
________________________________________________________________
Signature of Applicant
Date
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History of Certificated Classes
180 hours of Certificated Science of Mind classes are mandatory to enter
Professional Practitioner Studies Program
Student Name______________________________________________________________________
Address___________________________________________________________________________
City __________________________________ State ____________ Zip Code __________________
Phone___________________________ email____________________________________________
Other name(s) under which previous classes may have been filed: _____________________________
Please complete the information below. For classes taken at other spiritual communities, please attach a
copy of Certificates of Completion or obtain a transcript from the community the corresponding class was
taken. If unsure of any of your records, contact the spiritual community where the course was taken.
Class Name
Date
Completed
Instructors Name
Other Spiritual Community
name & address
SOM I or SOMAS 101
SOM II or SOMAS 201
SOM III or SOMAS 301
SOMAS 401 – Ernest
Holmes
SOMAS 402- Thomas
Troward
SOMAS 501-Practical
Mysticism
SOMAS 601-Technologies
of Conscious Living
Other communities classes
Practitioner I
Practitioner II
If you need any assistance filling out this form, please contact Registrar at (720) 974-2242.
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Professional Practitioner Studies Program
Workshop Prerequisite History
Note: All workshops must be current within last five years prior to application
Workshop Name
Date Taken
3 of 6 Required
Bridge Of Dreams
Bridge of Awakening
Bridge of Expression
What Will Set You Free
What Will Set You Free Level II
Inner Child Journey
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