Samuel Group l Diocese of Erie l 2022-2023
PLEASE COMPLETE THIS FORM IF YOU ARE INTERESTED IN JOINING THE GROUP AND WE WILL CONTACT YOU WITH MORE DETAILS. For more information visit erie.org/youth or email jzaczyk@eriercd.org.
Name
*
First Name
Last Name
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address (Work or Home address will help us assign the closest available spiritual director if you do not currently have one)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your current vocational status?
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Single
Separated
Divorced
Widowed
Other
What is your religious affliation?
*
Do you have children?
*
Yes
No
Do you have a spiritual director already?
*
Yes
No
If "yes," are you finding your spiritual direction appointments helpful?
Are you currently working?
*
Yes
No
If "yes," what is your current occupation?
Are you a college student?
*
Yes
No
Graduate Student
If "yes," what institution do you attend?
When is the best time to reach you for a quick video interview? (15-20 mins)? Please check all that apply:
*
Morning
Afternoon
Weekend
What does it mean for you when you hear, “Discerning your vocation?"
*
What is your goal or hope in attending the Samuel Group?
*
How did you hear about the Samuel Group?
*
Social Media/website
Flyer
Referred by a team coordinator, Fr. Mike, or Jillian
My parish
Other
I am committed to...
*
Small group sharing
Praying daily
Attending all the sessions
Having spiritual direction once a month
If “no” to any of the options above, what obstacles do you have to committing?
Submit
Should be Empty: