Petition for Certificate

Certificate of Theology Petition

Please complete this form if you have determined that you are eligible to petition for a Certificate of Theology (Please be aware that a $25 fee will be assessed to your account).
Legal Name: Your Legal name as it appears on your PBC Records.*
First Middle Last
Name on your Certificate: Please provide your name exactly as it should appear on your certificate using both upper and lower case letters. Please include any periods, apostrophes, accent marks or special characters.*
First Middle Last
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Are you a part of a PBC Affiliate Program?*
Please list what PBC Affiliate Program you are apart of.*

(N/A if does not apply)
Electronic Agreement*
I verify that all the information I have provided is accurate.

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