Application to Lead an Activity in the Spiritual Centre

Name*

First Last

Student Number

(if applicable)

Email*

Phone*

Type of Activity*

Select all that apply*

Prayer

Khutbah

Meeting/discussion group

Education

Religious counselling

Other

Please specify*

Description of Activity*

Frequency of Proposed Activity*

Preferred Day(s) and Time(s)*

Click the plus sign (+) to the right to add more days and times.

Day

Time

Preferred Start Date*

Number of Participants*

Minimum

Maximum

Special Equipment Needed*

Do you represent a recognized religious or spiritual organization?*

Qualifications*

(certification, training, experience)

References*

Click the plus sign (+) to the right to add more references as required.

Full Name

Position

Phone

To ensure that all activities in the Spiritual Centre are equally accessible to all students, there shall be no solicitation of money for goods or services offered in the Spiritual Centre, and no solicitation of donations to individuals or organizations.

As an activity leader at Algonquin College’s Spiritual Centre, I agree to the following:

To uphold the values of caring, learning, integrity, and respect;
To ensure a healthy environment where each member of the Algonquin College community can practise spirituality freely and with integrity and respect;
To ensure that the practices and expressions of spirituality do not infringe on the rights of others or contravene any College policy.

I agree to the statement above*

Yes

Date*

Appendix 1

Request for Authorization to Engage in the Algonquin College Spiritual Centre

Algonquin College interviews and approves persons who wish to provide religious services and spiritual care in multi-faith environments. Based upon your training, experience, and the endorsement of your faith group, you will be assessed as to your suitability for such a volunteer position.

You are asked to complete this application form. If there are questions you are unable, or choose not to answer, please state the reasons.

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Business

Fax

Home

Cell

Languages Spoken Proficiently*

Ordaining/Commissioning Authority

(If applicable)

Name

Date

Faith Group Authority*

Name

Address

Postal Code

Education*

Please select all that apply

College or University

Theological and/or Post-Graduate Studies

Supervised Pastoral Education

Faith Group or Religious Training

Other

Please specify

College or University*

Click the plus sign (+) to the right to add more studies

Name and Location

Major Subject

Dates Attended

Post-Secondary Degree Complete

Theological and/or Post-Graduate Studies*

Click the plus sign (+) to the right to add more studies

Name and Location

Dates Attended

Post-Secondary Degree Complete

Supervised Pastoral Education*

List in chronological order your four (4) most recent units of S.P.E. (either P.C.E. or C.P.E.) Click the plus sign (+) to the right to add more studies.

Centre

Level Basic/Advanced

Dates Attended

Supervisor

Faith Group or Religious Training*

Click the plus sign (+) to the right to add more studies.

Name and Location

Dates Attended

Post-Secondary Degree Complete

Other related experiences that qualify you*

(Please describe)

Authorization (Full Name)*

Pursuant to Section 39(1) of the Freedom of Information and Protection of Privacy Act, I ( name in full) _________________________________ authorize Algonquin College and its staff to contact the person or organizations listed below for the purposes of obtaining reference information.

References

Spiritual Advisor or other person who will attest to spiritual/religious maturity:*

First Last

Position/Title*

Name of Organization*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

References

S.P.E. Supervisor or other person who will attest to clinical abilities:*

First Last

Position/Title*

Name of Organization*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

References

The person to whom you have sent the certificate of faith group endorsement:*

First Last

Position/Title*

Name of Organization*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Faith History Please briefly answer the following questions.

Give a brief background of your religious affiliation and personal faith development.*

Describe a personal understanding of a belief that comes directly from your faith tradition and how that belief has changed for you over time.*

Describe some of the cultural practices of your faith group or community and their significance and meaning for you.*

How do you deal with your faith group’s stance concerning other faith groups, when it is in conflict with your personal beliefs?*

I hereby declare that, to my knowledge, the foregoing information is true and complete, and if authorized to volunteer for Algonquin College’s Spiritual Centre, I approve my credentials and a brief biographical information be publicized in College communications regarding the Spiritual Centre.*

I agree

Date*

Are you applying for chaplaincy membership?*

Appendix 2

Certificate of Endorsement

If you are applying for chaplaincy membership, please ensure Appendix 2, “Certificate of Religious/Spiritual Group Endorsement” is completed by the Faith Group Authority indicated in Appendix 1 and returned to Algonquin College.

Appendix 2 can be found here, and will also be emailed to the applicant for completion by the Faith Group Authority once this form is submitted.

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Spiritual Centre

Application to Lead an Activity in the Spiritual Centre

Appendix 1

Appendix 2

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Pembroke

Perth

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