Spiritual Care Visitor Training Application

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

Register early as the application process will close when we reach 20 students per retreat session or two weeks prior to the retreat date, whichever comes first.

Application for Enrollment — Spiritual Care Visitor Training

I am registering for (please select one - all times are Central Time Zone)*
- Fall 2023 In Person (Saturday, 9/30/23 9a-3p; Led by The Rev. Thomas S. Rogers, III; Bishop Anderson House, Chicago)
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 $50 application fee online. The application fee is non-refundable. For 2023, 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 a Professional Reference 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. By signing the application, you give us permission to contact this person.
Name of Organization*
Professional Reference's Name*
First Last
Professional Reference's Phone*
Professional Reference'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