Name    ______________________________________________________

Address   ______________________________Home Phone  ____________

City/State/Zip   _________________________Work Phone  _____________

1. Describe why you are interested in becoming a Stephen Minister.

2. What spiritual gifts or strengths do you believe God has given you that would help you serve effectively as a Stephen Minister?

3. In what ways do you think you would benefit personally from your training and service as a Stephen Minister?

4. Based on your current understanding of what it means to be a Stephen Minister, what do you think would be difficult or challenging aspects of this role for you?

5. How would people who know you describe the way you relate to others?

6. Describe briefly your relationship with Jesus Christ.

7. Are you willing to commit to serve faithfully for a period of no less than two years?  This includes:

 The initial 28-32 hours of training;
 Regular visits to your care receiver (weekly or a mutually agreed-upon frequency); and
 Once or twice monthly Small Group Peer Supervision
         
                      ____    Yes          ____     No
      
What changes would you need to make in your life in order to fulfill this commitment?

8. Have you ever received treatment for any emotional or psychiatric problems?

                 ____    Yes ____    No

If yes, a Stephen Leader will speak with you about this so that the team may better understand its significance in your life and ministry.

(Note: A great many caregivers have been made stronger in their Caregiving ministry through the care they themselves have received, including care from mental health professionals.  Your Stephen Leader Team affirms the work of the mental health professionals, who have helped many individuals to experience growth and healing.  This information is requested because the team wants to be fully informed about their Stephen Ministers.)

Please provide three references who are not members of this congregation if requested.



Please read and sign below.

The information I have provided in this application is true and complete to the best of my knowledge.  I agree to participate in Stephen Ministry training, in Small Group Peer Supervision, and to function within the boundaries of Stephen Ministry as adopted by my congregation.  I give permission for the congregation , if it deems necessary, to call for references, secure a background check on me and consult with the physician(s) or other mental health professionals regarding the nature of any treatment I have received for emotional or psychiatric problems.

Signature   __________________________________________

Date    _____________________________________________

Thank you for completing this application. Please send it to either:

Rosie Hochstetler
755 Elliott Court
Iowa City, IA 52246
319-358 - 2520
hifive@mchsi.com

or

Erma Edwards
606 5th Street
Kalona, IA 52247
319-656-5210
ermame@juno.com