Stephen Minister Application

Stephen Minister

Application
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Email*
example@example.com
Phone*

Area CodePhone Number
Describe why you are interested in becoming a Stephen Minister:*
What spiritual gifts or strengths do you believe God has given you that would help you serve effectively as a Stephen Minister?*
In what ways do you think you would benefit personally from your training and service as a Stephen Minister?*
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?*
How would people who know you describe the way you relate to others?*

Are you willing to commit to serve faithfully for a period of no less than two years? This includes: the initial 50 hours of training; regular visits to your care receiver (weekly or a mutually agreed- upon frequency); and twice-monthly Small Group Peer Supervision. *

YesNo
What changes would you need to make in your life in order to fulfill this commitment?*
Describe briefly your relationship with Jesus Christ.*

Have you ever trained and served as a Stephen Minister or Stephen Leader at another congregation?*

YesNo
If yes, please list where and when.
Please include the name and telephone number of a pastor and/or Stephen Leader there whom we can contact.
Have you ever received treatment for any emotional or psychiatric problems?*

YesNo
If yes, someone from the Stephen Leader Team 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 mental health professionals, who have helped many individuals to experience growth and healing. Members of the Stephen Leader Team request this information because they want to be as fully informed as possible about their Stephen Ministers.)
Have you ever been charged with a crime?*

YesNo
If yes, explain in detail. Someone from the Stephen Leader Team will speak with you about this so that the team may better understand its significance in your life and ministry.

References
Please provide three references who are not members of this congregation.
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Relationship
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Relationship
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Relationship
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 and in Small Group Peer Supervision and to function within the boundaries of Stephen Ministry as adopted by my congregation/organization. I give permission for the congregation/organization, if it deems necessary, to call my references, secure a police background check on me, and consult with the treating physician(s) or other mental health professionals regarding the nature of my treatment I have received for emotional or psychiatric problems.
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Stephen Minister