ONLINE APPLICATION FORM

Personal Information

Full Legal Name(Required)

First Name Middle Name Last Name

Preferred name to be called

Date of Birth(Required)

Marital Status

Single

Married

Wedding Date

Name of Spouse

First Last

Children's Details

Name of Child

Gender

Age

Grandchildren’s Details

Name of Grandchildren

Gender

Age

Contact Information

Home Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Preferred Email Address(Required)

Mobile Number(Required)

Emergency Contact Name(Required)

First Name Last Name

Emergency Mobile Number(Required)

Background and Context

New Birth in Christ (approximate date or age):

Holy Spirit Baptism (if applicable, date or age):

Denomination or Religious Affiliation:

Name of Local Church:

Name of Lead Pastor:

Your Clerical Status (if applicable):

Your Ministry: Position, Title, or Portfolio (if applicable) - Full Time? Part Time? Volunteer? Retired?

Other Work or Occupation: Position, Title, or Portfolio (if applicable): Full Time? Part Time? Volunteer? Retired?

• You may want to inquire to see whether your local church, institution, or organization would consider sponsoring or supporting (at least in prayer) your training as a spiritual director.

Educational Summary

List Degree/s

Institution/s Name/s

Date/s

How long have you been receiving spiritual direction? Name of Current Director(Required)

How long have you been receiving spiritual direction? (Required)

Name of current director (Required)

References

Reference 1

Name(Required)

First Last

Title or Relationship(Required)

Mobile Number(Required)

Email(Required)

Reference 2

Name(Required)

First Last

Title or Relationship(Required)

Mobile Number(Required)

Email(Required)

To Help Us Serve You

Remember to reach out to both of your references and ask them to email their short letters to comm@sherpaclimb.org detailing their understanding of your personal spiritual health and your potential as a spiritual director including their impressions of your self-awareness and sensitivity to the Holy Spirit and to others.

Do you have any disabilities that we should prepare to accommodate (especially on pilgrimage)?(Required)

Yes

Please Explain

Do you have any medical conditions that may require emergency care?(Required)

Yes

Please Explain

Do you have any allergies?(Required)

Yes

Please list

Do you have any specific dietary restrictions?(Required)

Yes

Explain (For example, do you require a gluten-free diet? If you are a vegetarian, please indicate what type of vegetarian. Do you eat fish, dairy, or eggs?)

• When we contract with Retreat Centers, they often inquire about any dietary restrictions of our participants. Though some severe restrictions cannot be met (and at times they offer refrigeration to those who must bring their own food), they usually try their best to meet dietary needs (though not simple preferences). Thus, knowing this information ahead of time can help Sherpa make reasonable accommodations for its participants

Do you have any specific physical restrictions?(Required)

Yes

Explain (For example, Do you have any difficulty walking short distances? … long distances? … climbing stairs? Do you have difficulty hearing? … seeing? … sitting?)

• Most pilgrimages involve much walking, sometimes strenuous; still we’ve been able to provide some alternative options even on pilgrimages. Knowing our travelers’ needs ahead of time gives us the opportunity to research and make recommendations.

Ways You Enjoy Helping

While in Sherpa, specify ways you enjoy sharing:

While in Sherpa, specify ways you would enjoy sharing:

Music: worship leading, singing, playing

Speaking/Teaching

Assisting

Other

Please explain