AMP Mentor Registration Form

By completed the form below you are registering as an Applied Ministry Practicum mentor for the MAC at Westminster Theological Seminary.

Mentor first name

Mentor last name

Mentor email

Student name

Please describe the experience and/or training that you received in counseling.

This intended to answer the question, "Why do you believe you were asked to serve as biblical counseling mentor to the student in our program?"

Expected practicum end date

I agree to meet regularly with the above student to provide feedback, encouragement, and concrete examples for growth.

YesNo

Please elaborate

I agree to sign off on hours documented for the above student before the final AMP evaluation.

YesNo

Please elaborate

I understand the framework of Biblical Counseling presented at Westminster Theological Seminary/Christian Counseling & Educational Foundation and I am equipped to give counseling feedback, encouragement, and challenge to the student listed above

YesNo

Please elaborate

I agree to the statement: "I am not a relative, spouse, or live in the same dwelling as the student I am mentoring."

YesNo

Please elaborate

Mentor signature

Sign above by typing your name.