Application for Admission

Please copy to a Microsoft Word Doc.  Insert and type in all requested information.  Save to your computer.  Send as an attachment to: [email protected] - or- snail mail to +Tom Simota, 2212 Oakwood Ave, Bentonville, AR 72712

Contact Information

Name:

Email:

Cell phone:

Home phone:

Work phone:                                                                          

Mailing address:

Astrological Information

Birth Date:                                                                             

Exact Time:

City/State:

Personal References (Very Important!)

Please insert the names, emails and telephone numbers of three people who know you well and would recommend you for ordination:

1.    Name:

Email:

Telephone:

2.    Name:

Email:

Telephone:

3.    Name:

Email:

Telephone:

Spiritual Teachers

Please insert the names of Spiritual Teachers with whom you have studied and any degrees or certifications that were received:

1.    Name:

Approximate dates:

Degree/Certification:

2.    Name:

Approximate dates:

Degree/Certification:

3.    Name:

Approximate dates:

Degree/Certification:

4.    Name:

Approximate dates:

Degree/Certification:

5.    Name:

Approximate dates:

Degree/Certification:

Spiritual Training and Certificates

Please insert the names of Spiritual Training and Certificates you have received:

1.    Title:

Instructor/Institution:

Dates

2.    Title:

Instructor/Institution:

Dates

3.    Title:

Instructor/Institution:

Dates

4.    Title:

Instructor/Institution:

Dates

5.    Title:

Instructor/Institution:

Dates

Academic Training and Certificates

Please insert the names of Academic Training/Licenses/Certificates you have received:

1.    Title:

Instructor/Institution:

Dates

2.    Title:

Instructor/Institution:

Dates

3.    Title:

Instructor/Institution:

Dates

4.    Title:

Instructor/Institution:

Dates

5.    Title:

Instructor/Institution:

Dates

General Questions

Have you received any honorary degrees, honors, distinctions or special recognitions:

What is your current work or profession:

Do you have any special needs that our program can try to accommodate (dyslexia, deafness, blindness, etc.)?  If so, how can we work with you in specific areas of the curriculum:

If you are in a committed relationship, do you have the full support of your spouse/significant other/life partner as you pursue the Path of Holy Orders?

Spiritual Questions

What is your motivation for seeking the Path of Holy Orders/Initiation:

How do you currently minister to the spiritual and material needs of others:

Briefly describe your most significant religious, theological, moral or other spiritual beliefs/viewpoints:

What are your current spiritual practices and religious affiliations:

Please describe the personal spiritual regimen that you follow:

What practices do you engage in to expand your mind and heart:

Sacramental Questions

Denomination, location and approximate date of Baptism:

Denomination, location and approximate date of Confirmation:

Denomination, location and approximate date of previous Ordinations:

Please describe what Holy Communion means for you spiritually:

Optional Autobiography

If you have further information that you would like to share regarding your personal, professional or spiritual life, you are welcome to include that information here:

Statement of Identity

As Travelers on The Path, we seek to reconnect to Cosmology and our sacred place in Creation.  The Aquarian Catholic Spiritual Community, an Esoteric Christian organization, cordially invites you to join us for classes, rituals and worship.  Together we grow in divine love, grace, knowledge and understanding.  Our activities seek to heal, to strengthen and to inspire us each on our spiritual path.  We honor Divinity within Humanity.

Statement of Non-Discrimination

The Aquarian Catholic Spiritual Community, School of Sacred Studies, and Path of Holy Orders/Initiation, is open to all sincere aspirants.  The ACSC believes that all humanity is becoming One family; we love all religions, traditions, nations, and races without discrimination of age, color, creed, gender, sexual orientation or status as a veteran.

Statement of Assent

I give permission for the ACSC to contact the above personal and professional references, spiritual teachers and academic institutions.  I also certify that all the information given by me in this application is true to the best of my knowledge.  I have read the ACSCs statements of Identity and Non-Discrimination and am in harmony with both statements.

Name:

Date:

Thank you for your conscientious work in filling out this application!