Spiritual Care Visitor Training Application

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

Class size is limited to 20 students. Please register early!

Application for Enrollment — Spiritual Care Visitor Training

I am registering for (please select one - all times are local time zones)*
- Fall 2024 In Person (Saturday, 9/28/24 9a-3p; Led by The Rev. Thomas S. Rogers, III; Trinity in the Woods, Farmington Hills, MI)
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 in caring for others 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 the communities you serve?*
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 support others spiritually and emotionally in your community for two hours each week. Do you have ideas for this?*
Application Fee*
- Please click here to submit your $75 registration fee online. The registration fee is non-refundable. For 2024, the tuition fee of $325 has been waived due to foundation grant support for the program.
Optional Donation
- If you would like to support the ministries of Bishop Anderson House, please click here to make a tax deductible donation.
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 your mentor who can speak to your aptitude supporting individuals you’ll be supporting spiritually and emotionally. This could be a faith community leader if you are active in your church/synagogue/temple/mosque, sangha; a social worker if you volunteer at a social justice organization or a hospice; or a supervisor at work who is familiar with your spiritual and emotional maturity. This person will be your mentor and support you while in the program and beyond. By signing the application, you give us permission to contact this person.
Name of Organization*
Mentor's Name*
First Last
Mentor's Phone*
Mentor'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