Please fill this out and press submit before March 11. Name *FirstLastDo you serve as a chaplain in *HealthcareCorrectional facility Police Fire Dept.Military OtherIf Other, please specifyIf Military, are you active, in the reserves, National Guard, other branches of the military etc Please specify what type of facility you work in Location of the facilityAre you professionally trained?YesNoIf yes, what type of training?What are your credentials?Are you?Full timePart timePer diemVolunteerSemi retiredRetiredSecular Degrees Rabbinic SmichaAre you a Rav of a shul?YesNoIf yes, please specify the name of the shul and locationEmailSubmit
