Name
*
First Name
Last Name
Address
*
Permanent Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Preferred Phone
*
(###)
###
####
Email
*
T-Shirt Size
*
X-Small
Small
Medium
Large
X-Large
Please share briefly about a spiritual practice that you do that you find meaningful. A few examples might be: (prayer, reading scripture, attending worship, meditation).
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What are your perceived gifts for ministry and how would you like to utilize them at the completion of the training?
*
How will your training as a spiritual care visitor contribute to your faith community?
*
If you’ve had the experience of making spiritual care visits, please tell us about one of your visits.
*
As part of the program, you will be asked to engage in listening with others a total of 12 hours over the three months of the program. Do you have ideas for where/how you will accomplish this?
*
Program Date
*
Faith Community Leader's Name
*
Faith Community Leader's Phone
*
(###)
###
####
Faith Community Leader's Email
*
Electronic Signature Confirmation
*
By typing my name below, I acknowledge that I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.
First Name
Last Name
Date
*
MM
DD
YYYY
