CBTS Mentor Registration
Student Information
Student Name
*
First Name
Last Name
Student's Email
*
example@example.com
Degree Program
*
Please Select
MDiv
BDiv
MAPS
DPS
Mentor Information
Mentor Name
*
First Name
Last Name
Mentor's pastoral status and history (how long in the ministry and where?)
*
Mentor's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mentor's Email
*
example@example.com
Mentor's Phone Number
*
Please verify that you are human
*
Submit
Should be Empty: