J-Term Grant Registration Form

Name

First NameLast Name

Preferred Pronouns

Preferred Email

example@example.com

Preferred Phone Number

Please enter a valid phone number.

Seminary

I am requesting a grant to cover (choose one option)

Option 1 - Tuition for this courseOption 2 - Housing, Food and Travel Assistance

If you are requesting Option 1: Tuition from the Deaconess Community, Luther Seminary will send us an invoice and we will pay Luther Seminary or your seminary directly.

You are responsible for your travel and retreat center housing and food
costs.

Double occupancy housing and food starting with supper on January 5 and ending with breakfast on January 11 (6 nights) is $810 per person. We'll adjust your price if you need fewer nights or meals because of arrival and departure times. Single occupancy housing may be requested, subject to availability for $1,020 per person. Please pay these fees by the last day of class.

If you are requesting Option 2: Housing, Food and Travel Assistance, Travel Assistance will be sent to you after the conclusion of the course upon submission of an Expense Form. We recommend that you book refundable tickets as the Deaconess Community will not reimburse travel if the class is canceled, changed to an electronic format, or the student withdraws from the class.

Venue
Carmelite Spiritual Center, Darien, Illinois https://carmelitespiritualcenter.org/

Reservations for the dates of the class will be made by the Deaconess Community.
If you will be arriving early or departing late, please contact the retreat center directly to confirm they have rooms available and to make the reservation for your additional days. Let them know you are with the Deaconess Community of the ELCA group.

I am requesting:

Double occupancy housing (covered with Option 2, Housing, Food and Travel Assistance)

Please list rooming preferences, if any:

Single occupancy housing if available (requires an additional $210 paid to the Deaconess Community for those choosing Option 2 Grant and $1,020 for those choosing Option 1 Grant)

This fee is due the last day of class.

Dietary restrictions
Please note: We will incur an additional daily charge for special meals. Please indicate dietary restrictions rather than preferences. While dietary restrictions will be provided to the retreat center’s chef, menu choices are the purview of the establishment. We appreciate your help in stewarding our dollars.

NoneVegetarianVeganGluten-free

Other:

General Logistics

I give the Deaconess Community permission to use photos of me from the class for communication or promotional purposes.

YesNo

Other:

I understand that if I withdraw from the course after December 6, 2025, I will be responsible to pay for my housing and food (double occupancy $810).*

Yes

Please enter the date/time of your arrival.
Keep in mind the first class begins at 4:00 pm on Sunday, January 5, 2025.

Arrival Date

Date

Arrival Time

Hour Minutes

AM/PM Option

Please enter the date/time of your departure.
Keep in mind the last class will end at 4:00 pm on Friday, January 10, 2025.

Departure Date

Date

Departure Time

Hour Minutes

AM/PM Option