Spiritual Care Visitor Training Application

For more information and questions, contact Kim Lessner at 312-563-4825 or Kim_Lessner@rush.edu.

Application for Enrollment — Spiritual Care Visitor Training

I am registering for (please select one - all times are Central Time Zone)*
- Winter 2023 via Zoom (Saturday, 1/21/23 10a-3p AND Saturday, 1/28/23 10a-12:30p; Led by The Rev. Thomas S. Rogers, III)
- Spring 2023 In Person (Saturday, 3/25/23 9a-3p; Led by The Rev. Dr. Micheal A. Smith; Location TBD)
- Fall 2023 In Person (Saturday, 9/30/23 9a-3p; Led by The Rev. Thomas S. Rogers, III; Location TBD)
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Preferred Phone Number*
Email*
Spiritual Information
We would like to learn more about you. Please briefly answer the following questions.
Please share briefly about a spiritual practice that you participate in that you find meaningful. A few examples might be: (prayer, reading scripture, attending worship, meditation).*
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 a visit.*
As part of the program you will be asked to engage in ministry two hours each week. Do you have ideas for this?*
Application Fee
- Please follow link to submit your $50 application fee online. The application fee is non-refundable. A balance of $325 will be due upon acceptance to the program. Tuition is non-refundable once you have been given access to the online learning system. You can make a payment here.
Background Check
- Once you submit the form, you will receive a link via email from Kim at KIm_Lessner@rush.edu concerning your background check. Click the link and complete the background check information. Please email Kim if you don’t receive a link within 3 days.
If you have had a background check in the past three years please provide the name, phone number and email address of who we can contact to obtain the information.
Electronic Signatures
Please share the name, email, and phone number of a leader from your Faith Community that can speak to your gifts for being a spiritual care visitor. By signing the application, you give us permission to contact this person.
Name of Faith Community*
Faith Community Leader's Name*
First Last
Faith Community Leader's Phone*
Faith Community Leader's Email*
Authorization of Electronic Signature*
- I agree that this will be used as my electronic signature.
Your Name*
First Last
Date*
MM slash DD slash YYYY

Spiritual Care Visitor Training Application

Application for Enrollment — Spiritual Care Visitor Training

Spiritual Information

Electronic Signatures

Title