Instructions:
(1) Please use your Printer Browser Button to print out one copy of this Form.
(2) PLEASE WRITE CLEARLY OR TYPE.
(3) Please check all areas that apply.
(4) Attach and number your documentation accordingly.
(5) Sign and date this Form.
(6) Send this Form with all documentation and the Service Fee to:
NAME OF APPLICANT _____________________________________________
PHONE NUMBER: (eve) ____________________ (day)__________________
POSTAL MAILING ADDRESS:
________________________________________________________________
__ This Credit Assessment is submitted as an attachment to my Application at St. Elias School of Orthodox Theology.
__ This Credit Assessment is submitted for an independent Credential Review.
I have enclosed the non-refundable $40 Service-Fee (foreign credits/countries $75).
1. Printed Materials: Please number each item, starting with “101”.
__ Enclosed is a copy/are copies of a Book or Books I have published
__ Enclosed is a copy/are copies of a magazine/newspaper article or articles I have published.
__ Enclosed is a copy/are copies of an Internet article or articles I have published.
Please also include the URL for verification purposes.
__ Enclosed are copies of essays I have composed.
__ Enclosed are copies of letters I have written.
2. Media: Please number each item, starting with “201”.
__ Enclosed is a tape of a TV show/interview/presentation I have given
Please label and number each video tape. Also indicate the recording time, the TV station and the date of broadcasting.
__ Enclosed is a tape of a Radio show/interview/presentation I have given.
Please label and number each audio tape. Also indicate the recording time, the Radio station and the date of broadcasting.
__ Enclosed is a video tape I wish to present.
Please label and number each video tape. Also indicate the recording time and the date when it was recorded.
__ Enclosed is an audio tape I wish to present. Also indicate the recording time and the date when it was recorded.
3. Practical Experience: Please number each item, starting with “301”.
__ Enclosed is a summery of my pastoral experience. Must be typewritten, dated and signed.
__ Enclosed are reference letters attesting to pastoral experience
__ Enclosed are newspaper articles attesting to my pastoral experience
__ Enclosed are church newsletters/bulletins attesting to my pastoral experience
__ Enclosed are community references
4. External Credits: Please number each item, starting with “401”.
__ Enclosed are transcripts from former credits achieved.
__ Enclosed are Achievement Certificates
__ Enclosed are Award Certificates
5. Other: Please number each item, starting with “501”.
__ Enclosed is documentation that I think may qualify for external credits.
I affirm that I have honestly presented this form and that the attached documentation is true and authentic. The documentation I hereby submit will be kept in the St. Elias School Archives.
I realize that incomplete documentation (based on the above-indicated requirements) and that illegible or bad copies will not be considered when my credential review is conducted. Once my Credential Review is completed, I will receive a written Credential Review Report, which is final.
Signature: ____________________________________________Date_______________