Certificate Application

Certificate Application Form

Fields marked with an * are required

Name(Required)

Email(Required)

Phone(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Church Name *(Required)

I am submitting this application for Care & Discipleship level:(Required)

Level 1

Level 2

Level 3 (Observation)

$75 Application Fee(Required)

I have paid via application product online (preferred)

I am mailing a check

I have completed the required videos and reading(Required)

Yes

I have submitted the required level exam(Required)

Yes (via email to cdc@ibcd.org)

(For Level 3 Observation only)

I have submitted the Reading Response Paper

I have submitted the Observation Log and Reflection Paper

Elective 1 - Message Title(Required)

Elective 2 - Message Title(Required)

Elective 3 - Message Title(Required)

Name to print on certificate(Required)