Chaplaincy Registration Form

Name:

Mailing Address:

 Course 1: Introduction to Hindu Chaplaincy
 Course 2: Basics of Pastoral and Spiritual Counseling
(Admission to Course 2 will be granted after satisfactory completion of Course 1)

Phone Number:

Alternate Phone Number:

Email ID:

Skype Id (Optional) :

Educational Details::

Institution Location Degree/Diploma/Certificate Obtained

Motivation for enrolling in the Hindu Chaplaincy Certification Program::

Other Concerns or Comments:

Dated Signature of Student:

Payment via check: 
Please mail in a check payable to "Hindu University of America" for the amount of $500. The mailing address for the check is:
Mr. Satya Gupta,
Hindu University of America - South Florida Center
5340 North Federal Highway, Suite 104, Lighthouse Point, FL-33064
Please do mention your name on the check.
OR
Online Payment: