Request a Stephen Minister

Request a Stephen Minister
MyselfFamily or Friend
Name of person submitting application:
Contact phone number for the person submitting application:

Area CodePhone Number
YesNo
Tell Us About The Person Receiving Care
YesNo
Today's date

MonthDayYear
Date
Name of Person Receiving Care*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of birth *

MonthDayYear
Date
Email*
example@example.com
Phone Number*

Area CodePhone Number
In what ways do you think you would benefit personally from having a Stephen Minister?*
YesNo, not at this timeOther
What should I expect from a Stephen Minister?
- Stephen Minister will meet privately with one care receiver of the same gender.
- Stephen Minister is a trained and supervised lay volunteer, not a professional counselor, therapist, pastor or physician.
- Stephen Ministers are Christians that care in the name of Christ that are willing to talk about spiritual issues but will not force them.
- Stephen Minister will provide care by listening, supporting, encouraging, praying, being dependable and trustworthy.
- Stephen Minister will keep personal information confidential so that the care receiver can feel free to share without worry of it being disclosed.
Small Group Peer Supervision

Stephen Ministers meet periodically to give and receive peer supervision in order to help them provide the best quality of care. In the supervisory session, they will talk about their caring relationships and their own feeling but will not reveal names or information that would identity their receivers.
Agreement to Receive Care By acknowledging below I understand the description of Stephen Ministry as explained in this application and desire to receive care from a Stephen Minister from Discovery Church. I further understand that confidentiality in Stephen Ministry as explained in this agreement and give my permission to my Stephen Minister, Stephen Leaders and pastoral staff of Discovery Church to care and receive supervision and to obtain consultation as described in the application.
YesNo
In Time of CrisisIn Need of Follow-upChronic Issues of LifePreparing for Life ChangeTrauma Support
- In Times of Crisis
  - examples: hospitalization, the death of a loved one, the loss of a job, a natural disaster
- In Need of Follow-up
  - examples: Crisis care examples after the event or incident has passed and grief has set in
- Chronic Issues of Life
  - examples: Chronic pain, chronic illness, disabilities, homebound
- Preparing for Life Change
  - examples: Expecting a child, approaching retirement, approaching empty-nest, getting married, going off to college or the military
- Trauma Support
  - examples: A person in the role of caregiver caring for their dying spouse, a person in the role of caregiver caring for their aged parent, a parent caring for an adult child through the pain of divorce
How did you hear about Stephen Ministry?
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Request a Stephen Minister

Tell Us About The Person Receiving Care