Application for Sabbatical Guests

The Ministry Institute of Mater Dei at
Gonzaga University
405 East Sinto Avenue
Spokane, Washington 99202

1-800-986-9585, Ext. 6012

Email: bartletts@gonzaga.edu

Fill out the online form below or download this Application Form(PDF)

General Information

First Name

Last Name

Date of Birth

mm/dd/yy

Country of Birth

Country of Citizenship

Address

City

State

Zip

Country

Phone

( ) -

E-mail

Educational and Professional Background

High School or Equivalent Completed Yes - Date No

College/University
	City/State
	Major Field
	Degree
	Date of Completion mm/dd/yy

Graduate University
	City/State
	Major Field
	Degree
	Date of Completion mm/dd/yy

Other Professional Training

Area of Training Date mm/dd/yy

Ministry Background

Please list major positions in ministry you have held in the last ten years, the length of ministry in each position, and your responsibilities and/or duties.

References

Please list two references with address and phone number.

If a religious, please have your superior send a letter of support.

If a priest, please have your bishop send a letter of reference and Celebret.

Name
	Addresss
	City/State Zip
	Phone ( ) -

Name
	Addresss
	City/State Zip
	Phone ( ) -

Health

Health problems, disabilities, or diet that need attention and care while I am on sabbatical

Please list any medications you are currently taking

Our participants are urged to have insurance coverage during their stay at the Ministry Institute. Please check below the coverage which you will have

I have insurance

I will purchase the Insurance Plan available through Gonzaga University

Please send an insurance brochure

Program Information

Fall (Aug-Dec)

Spring (Jan-Apr)

Summer (May-July)

Are you interested in Spiritual Direction for yourself while on sabbatical?
Yes No

Look for an important message after submitting this form.