Clergy Application for Emmaus Team

Name

First NameLast Name

Name you like to be called:

Address

Street Address

Street Address Line 2

CityState

Zip Code

Preferred Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Preferred Email

example@example.com

Are you an ordained minister?

Date of ordination

What is your clergy status?

(i.e. license, certified, deacon, etc.)

In what church or denomination?

What is your current professional ministry?

(i.e. pastor, chaplain, etc.)

Full or Part Time?

If a pastor, church(es) you currently pastor:

Your educational background: Please list the theological school(s) you have attended, the date(s) of graduation(s) and degree(s) you have earned in your ministerial training:

School - Year - Degree

Are you a retired minister in good standing?

Home Church

Your Emmaus and Chrysalis background (Where and when did you make your Emmaus Walk, or other 4th Day weekend?):

Have you attended an Emmaus/Chrysalis clergy training conducted by The Upper Room staff or a Clergy Regional Representative?

If yes, date & community:

Previous Team experiences as a layperson (Please list by Community name followed by Walk/Flight/Journey number, jobs held, talks given)

Previous Team experiences as a clergyperson (Please list by community name followed by Walk/Flight/Journey number)

For the Emmaus and Chrysalis Clergy talks listed below, please check all that you have given.

Have you ever served as the Weekend/Head Spiritual Director on a Walk/Flight/Journey?

If yes, give the community name and Walk/Flight/Journey number:

What Emmaus/Chrysalis Community Activities have you participated in?

Expected team participation:
Team formation is a 17 to 20-hour process prior to the weekend event. In the Dayspring Emmaus
Community, we gather at Orientation, Formation, Team Building, and Dedication. It is
understood that clergy are expected to attend all of the team meetings and preview their talks at
Formation. Specific team meetings that you would need to miss are coordinated with the
Weekend Spiritual Director and the Weekend Lay Director. There shall be at least two clergy
persons (WSD & AWSD) who will stay for the entire weekend for purposes of training and
support. All other clergy are expected to attend the entire weekend plus Follow-Up if possible.

Signature of Applicant

Date

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Clergy Application for Emmaus Team

Your Church Relationship