(This information is kept completely confidential)
Personal Info:
Name:
Address:
City: State:
Zip: Country:
Phone: (we will NOT call you unless it's dire...)
E-mail Address (Please type carefully):
Date of Birth:
Gender: MaleFemale
Marital Status:SingleMarriedDivorcedToo long a story for this space
Number of Children:Boy(s) Girl(s)
Partner's Name:
Please check the degree you would like to receive:
Doctor of Philosophy (Ph.D.) in ReligionDoctor of Philosophy (Ph.D.) in Religious StudiesDoctor of Philosophy (Ph.D.) in MetaphysicsOTHER Doctor of Philosophy (Ph.D.) you wish to request. Describe below:
Please enter your name exactly as you want it to appear on your Degree-Diploma. This is a formal document, you should include your middle name.
Do you pledge to use your new credentials only for the Service of Humanity?
The following questions help us build a picture of you and what has made you the person you are. We can better help you get where you're going if we have a complete profile of you and your spiritual background.
What religion were you raised on?
Do you still practice its ways?
FullySomewhat
SeldomNever
How does your immediate family feel about your chosen spiritual path? Opposition? Approval?
Please check any of the following areas you have studied or "dabbled" in:
Kabbalah
Esoteric Christianity
Runes
Rosicrucians
Gnosticism
Wicca or Earthbased Trads
Angels
Judaism
Buddhism
Ceremonial Magick
Tarot
Enochian
Goddess
Apocalyptic/ Prophecy studies
Druidry
Vedanta/Hinduism
Other areas of study not listed above:
Please list the subjects above that you are most interested in learning MORE about:
More about you
Your occupation:
Special Skills:
Hobbies, etc.?
How did you hear about us?
In a book
Link from Twitter
Friend, colleague, family member
Discussion List or Forum
Link from any other website
Search Engine QueryFacebook
Katia's Esoteric Christianity Blog
Other source: (please describe)
We will ordain you as a clergy member for no charge with your Degree. What kind of clergy title do you wish to be ordained as?
Choose how you want to be Ordained (more than one clergy title is okay for additional fee of $20 each. Separate certificates):
Interfaith MinisterSpiritual MinisterRabbiEsoteric Minister
Other Title-- Please describe:
You may choose more than one title from the above list for an additional $20 fee. (Separate certificates.)
Wallet ID credentials are included at no extra charge. We can email you a digital copy of your new credentials before we ship the hard-copy at no extra charge, just let us know
Your application will be reviewed and you will be notified immediately upon acceptance. Don't forget to also send us your 4000-word thesis on any spiritual topic.
The Doctorate Degree fee is $890 (includes Priority Mail shipping of your Documents). After you submit this form you will be directed to a payment page.
If you are having difficulty with the online application, you may print this and Mail to: Esoteric Interfaith Church, Inc. 650 N. Penrod Road, Suite 216 Show Low, AZ 85901
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