S A B B A T I C A L P R O G R A M Application
Name
Email
Address 1
City, State & Zip
Country
USA
Canada
France
Hm. Tel:
Wk. Tel:
Date of Birth
Current Ministry
Yrs. in Ministry
Ministry Despcription:
Give a brief statement pertaining to your expectations for this sabbatical:
Briefly describe any circumstances or situations that are currently affecting your:
(a) Personal Life
(b) Spiritual Life:
(c) Ministry:
(d) Relationships:
Do you have any signifcant Health Problems? (check one)
Yes
No
If so please explain:
Do you use any medications?
Yes
No
If so please explain:
Who referred you To Shalom Center?
Name and Address of Person Financially Responsible:
Name
Email
Address
City, State, Zip
Country
USA
Canada
France
Please list three references to include (1) a person in leadership, (2) spirtual director, (3) friend; and have each send a letter of reference to our attention.
