| Full Name of Applicant/Honoree: * | |
| Title of Applicant/Honoree: * | |
| Mailing Address: * | |
| City: * | |
| State: | |
| Country: * | |
| Zip/Postal Code: * | |
| E-mail Address: * | |
| Phone 1: * | |
| Phone 2: | |
| Marital Status: * | |
| Current Church/Ministry of Honoree: * | |
| Church/Ministry Address: City, State, Country, Zip * | |
| Church/Ministry Web Site URL: | |
| Three (3) Character References: include name, address, phone number and email * | |
| Cut and pastd the resume and accomplishments of the Honoree: * | |
| State the reasons you believe the Honoree is worthy of such honor and distinction: * | |
| Requested Honorary Degree: choose only one * | Doctorate of Divinity - DD
Doctorate of Letters - DL
Doctorate of Ministry - DMin
Doctorate of Divine Law - DDL
Doctorate of Sacred Theology - STD
Doctor of Philosophy in Religion - PhD |
| I (we) desire to be contacted to schedual a conferal service: * | |
| I (we) understand that there is a one-time, non-refundable application and conferal fee in the amount of $500.00, which is payable upon submission of this application: * | |
| I (we) understand that CBCTS is limited in the amount of Honorary Degrees issued each semester, and agree that if not accepted this semester, I (we) will be placed at the top of the list for the next semester: * | |
| Signature: * | |
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