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CONGREGATION OF THE HOLY SPIRITProvince of the United States

6230 Brush Run Road • Bethel Park, PA 15102-2214 • 412-831-0302 • www.spiritans.org • [email protected]

Application for Admission The following is the application for admission to the initial formation program of the Congregation of the Holy Spirit, Province of the United States. This process is broken down into three (3) stages. At the end of each stage, please submit the requested parts of the application.

Stage ICompleted Information Action Needed

□ I. General Information (p. 2) Complete and submit□ II. Education (p. 2) Complete and submit□ III. Religious History (p. 3) Complete and submit□ IV. Family Information (p. 4) Complete and submit□ V. Work Experience (p. 6) Complete and submit□ VI. Financial Statement (p. 7) Complete and submit

VII. Financial Policies of Initial Formation (p. 8) Information OnlyVIII. Financial Aid (p. 8) Information Only

□ IX. Autobiography (p. 9) Complete and submit□ X. References (p. 10) Complete and submit□ XI. Candidate Information Release Consent Form (p. 11) Complete and submit

When complete, submit the above together.

Stage IICompleted Information Action Needed

□ XII. Medical History (p. 12) Complete and submit□ XIII. Physical Examination (p. 13) Complete examination and submit□ XIV. Eye Examination (p. 14) Complete examination and submit□ XV. Dental Examination (p. 15) Complete examination and submit

□ XVI. Permission for Emergency Medical and Surgical Care (p.16 )

Compete and submit

When complete, submit the above together.

Stage IIIFinal Interview

of 16

Name:________________________________________________________Last First Middle .

Personal Information

Part I: General InformationPlease print clearly

Name:Last First Middle

Address: Phone: ( )(Current) (Number, City, State, Zip) Home

Address: Phone: ( )(Home) (Number, City, State, Zip) Mobile

Email: Phone: ( )Business

Birth Date:Date (mm/dd/yyyy) City State Country Age

U.S. Citizen? Yes Nocircle

If Naturalized:Final naturalized Number Date Place – City/State

Part II: EducationList all colleges/universities, secondary, and elementary schools attended: Indicate Public/Catholic/Private

Name of School (most recent first) Start Date End Date Degree

1.2.3.4.Please forward a transcript from each college/university you have attended.

You may indicate your most recent TOEFL, if English is your second language, or SAT/ACT score

What studies did you like best?Least?Activities, social, athletic, etc.Honors and awards receivedList philosophy courses, if takenSkills or special trainingForeign languages, if any,

You may attach additional sheets to answer the above questions.

of 16Received:_________/__________/__________


Part III: Religious History

Baptism:Date Parish City State

Confirmation:Date Parish City State

Present Parish: Pastor:Name/City/State Name

Home Parish: Pastor:Name/City/State Name

Convert to Catholicism? Yes No If yes:circle Date (mm/dd/yyyy)

Parish: Pastor:Name/City/State Name

What was your religious history prior to your conversion? (You may use additional sheets)

Have you ever been a non-practicing Catholic? Yes Nocircle

Did you join another church/denomination? Yes Nocircle

When and why did you return to the Catholic Church?

Have you ever been married? Yes No Is your wife still living? Yes Nocircle circle

If your wife is still living where and when were you married?

Place of Wedding Name of Church/Court Name of Official Date (mm/dd/yyyy)

Are you divorced? Yes No Date of Divorce:circle Date (mm/dd/yyyy)

Final divorce decree:

Case Number of Divorce Proceedings:

Diocese Granting Annulment: Case Number:

Your children, beginning with the oldest, and indicate with whom they live.

Name (Last, First, MI) Age Living With

of 16Received:_________/__________/__________


Have you studied for priesthood at another seminary? If yes, please provide the following information:

Name, Address Entrance Date Departure Date Reason for Leaving.

Name, Address Entrance Date Departure Date Reason for Leaving.

Did you enter a novitiate of another religious order or congregation? If yes, please provide the following information:

Name, Address Entrance Date Termination Date Reason for Leaving.

Name, Address Entrance Date Termination Date Reason for Leaving.

Part IV: Family Information

Are you an adopted child? Yes Nocircle

A. Your Father

Name:Last First Middle Age

Address:(current) Number, Street City State Zip

Phone: ( )

Date of Birth: Birth Place:Date (mm/dd/yyyy) city/state

Nationality Occupation Education Religion

If deceased, age Date (mm/dd/yyyy) Cause

B. Your Mother

Name:Last First Middle Age

Address:(current) Number, Street City State Zip

Phone: ( )

Date of Birth: Birth Place:Date (mm/dd/yyyy) City/Sstate

Nationality Occupation Education Religion

If deceased, age Date (mm/dd/yyyy) Cause

C. Your Parents’ History of 16

Received:_________/__________/__________


a. Married by Priest/Minister

Number, Street Where by whom which rite? Roman Catholic/Eastern

b. If your parents separatedYes No

Date (mm/dd/yyyy) Where Reconciled? When

c. if you one of your parents remarriedYes No Yes No

Divorced? One Parent Deceased? Step Parent Name With whom are you living?

d. Your step parent remarried

Date (mm/dd/yyyy) Where By Whom which rite? Roman Catholic/Eastern

D. Your Siblings

Name (Last, First, MI) Age Occupation Marital Status Religious Practice

E. Your relatives who are in religious life or the priesthood

Name sister/brother/priest Parish/Diocese/Congregation Location

F. Paternal Grandparents

Grandfather Yes NoName Living Age Where he lived

Grandmother Yes NoName Living Age Where she lived

G. Maternal Grandparents

Grandfather Yes NoName Living Age Where he lived

Grandmother Yes NoName Living Age Where she lived

of 16Received:_________/__________/__________


H. ResidencesList in reversed chronological order any previous addresses at which you have lived for a period of six months orlonger since you were 16 years of age.

Date Address City State Zip

I. In case of Emergency

Name Telephone Relationship

Part V: Work Experience

If you have never worked, please explain:Social Security Number

A. EmploymentList employment you have had for at least six months, beginning with the most recent.

Start Date End Date Employer Address Job Title/DutiesMonthly

Salary

B. Volunteer and Professional OrganizationsPlease name any volunteer work(s) or professional organizations to which you belong.

Start Date End Date Organization Address Job Title/DutiesAwards and Recognitions

of 16Received:_________/__________/__________


C. Military

If you registered for the draft, date of registration:Date Number

If you did not register for the draft, please explain why:

Service in the Armed Forces

Induction date Service Branch Serial Number Separation DatePlace of

Separation

Discharge received Rank at Discharge Highest Rank Obtained Kind of work in the Service

Part VI: Financial Statement

Assets LiabilitiesSaving Accounts Student Loads

Checking Accounts a.Stocks and Bonds b.

Trusts Bank LoansValue of Automobile Automobile LoanValue of Real Estate Co-Signed Loans

Assets not Listed Above Real Estate Mortgagea. Charge/Debit Cardsb. Other Debtsc. a.d. b.

Total Assets: Total Liabilities:

of 16Received:_________/__________/__________


Part VII: Financial Policies of Initial Formation

It is presumed that a candidate and his family will cover all expenses involved with the initial formation program, such as room and board, medical and dental care, spending money for personal needs, academic supplies, transportation, long distance phone calls, postage, and textbooks. Where the Formation community purchases textbooks, they shall remain in the community library at the completion of studies, property of the Congregation of the Holy Spirit. The Director of Formation will interview each candidate individually and dialogue with his family privately to determine each candidate’s financial capabilities. No candidate will be refused admission or continuance in the initial formation program because of the lack of finances.

The Congregation supports each candidate according to individual need, including monthly allowances which are privately given only when needed, as determined by the Director of Formation. Candidates are expected to work during the summer months to assist in providing for their financial needs for the following year. They also are expected to approach family members, possible benefactors, home pastor, parish organizations, etc., to ask for assistance.

Candidates and their families unable to afford health insurance to cover medical/drug needs, should work with the Director of Formation to determine which options are available to best serve the candidates needs.

We recognize that candidates come to us to learn about religious life. The period of initial formation is a time of discernment both for the individual and for the Spiritan community. Should this discernment lead a candidate to leave the formation program, he will assume responsibility for payment of all the loans which have been taken out in his name. When possible, he also has a moral responsibility for expenses that were incurred for his religious formation.

Part VIII: Financial Aid

Candidates whose families cannot afford to pay tuition and fees must apply for financial aid. Based on academic achievement and need, candidates are often eligible to receive grants of various types from outside sources; parishes, parish groups, endowments, scholarships, etc. Candidates may be eligible for government loans if they are unable to finance their own education. A copy of the of the candidate’s loan application (or other financial aid) should be given to the Formation Director before the school year begins. Catalogues from the institution to which the candidate is applying should be consulted for deadlines.

of 16Received:_________/__________/__________


Part IX: Autobiography

Please use the following outline to write your autobiography. Use white 8 ½’’x 11’’ paper. If you write it by hand, please use ruled paper.

Subdivide your autobiography into the following sections:1. Pre-school memories2. Memories of life during grades 1-83. Memories of high school4. Life at college (if applicable)5. What you have done since high school, if you did not attend college.6. What is your view of the present world?7. What are the challenges before us as people called to the Gospel?

When referring to the future, we are aware the future is uncertain; however, you do have goals and dreams for the future – for yourself, family, church, and for the world. Please share these with us.

Life is a process of learning, growth and change. Please share with us how you have grown through reflecting on the following points:

1. Your happiest and least happy memories2. Your religious experiences and attitudes3. Important people and events4. Friends and acquaintances5. The crises you experienced and their meanings6. Interactions within your changing family7. Books, travel, dating, friendship.

Return this sheet with your autobiography to:

The Congregation of the Holy SpiritProvince of the United States

Vocation Office6230 Brush Run Road

Bethel Park, PA 15102-2214

of 16Received:_________/__________/__________


Part X: ReferencesDirections: Please provide the addresses and phone numbers of three (3) personal references (including at least one from a family member and one from the pastor of your parish) and two (2) professional references, for a total of at least five (5) references. The Provincial Vocation director will contact these individuals and obtain the reference directly.




Personal Reference #1: (family member)

Name:Name Relationship

Address: Phone:(Number, City, State, Zip) please include area code

Personal Reference #2: (pastor)

Name:Name Pastor


Personal Reference #3: (other)



Professional Reference #1:



Professional Reference #2:



of 16Received:_________/__________/__________


Part XI: Consent to Release

Candidate Information ReleaseConsent Form

I hereby give consent to the Vocation Director of the Congregation of the Holy Spirit Province of the United States, to contact any of my former employers, educational institutions I have attended, and any other persons or organizations whom he might determine might have information relevant to my application.

I also, hereby, give consent to examining physicians, dentists, ophthalmologists, optometrists, and psychologists to release required summary reports and evaluations to the Vocation Director of the Congregation of the Holy Spirit Province of the United States, and to him only.

I understand that any information obtained by the Vocation Director of the Congregation of the Holy Spirit Province of the United States, will be treated in the strictest confidence.

I request that the appropriate summary reports and evaluations be released to:

Printed Name

Signature Date (mm/dd/yyyy)

of 16Received:_________/__________/__________


Part XII: Medical HistoryDirections: All questions must be answered. Incomplete records will not be accepted. This record will be kept strictlyconfidential. If more space is required for your answer, please attach an additional sheet and number the answer tocorrespond with the question. Please print clearly

1. Name:Last First Middle

2. Address: Phone: ( )(Number, City, State, Zip)

3. Emergency Contact: Phone: ( )Name Relationship

4. List AllWhen Reason Hospital Where

OperationsHospital VisitsSerious IllnessMental HealthTreated by Physician

5. Do you use the following?

Eye Glasses Braces, Extremity or Back Crutches

Contact Lenses Hearing Aid Artificial Limb or Eye

Eye Glasses/Contacts Constant Use Wheelchair Physical Deformities

Allergies or Medications:

Release Form [to be completed by parent or guardian if candidate is under the age of 21 years]

The law requires that parent or guardian permission be obtained for treatment for illness or injury of minors. In order that there is no delay in treatment of illness or injury, the following consent statement should be signed by your parent or legal guardian if you are younger than 21 years of age.

I give permission for such diagnostic, therapeutic and operative procedure as may be deemed necessary for my son in case of injury or illness.

Parent or Guardian Printed Name Relationship

Parent or Guardian Signature Date (mm/dd/yyyy)

Applicant’s Printed Name

Applicant’s Signature Date (mm/dd/yyyy)

of 16Received:_________/__________/__________


Part XIII: Physical Examination – Physician Only

1. General About the Patient

Height Weight Pulse (Sitting) Resp. B.P. (Sitting)

2. Basic InformationItem Normal Abnormal Additional Comments

Head, Face, Scalp, Skin □ □Neck, Nodes, Thyroid □ □Eyes, Ears, Nose, Sinuses □ □Mouth and Teeth □ □Pharynx and Tonsils □ □Lungs and Chest □ □Heart □ □Abdomen, Hernia, Scars □ □Genitalia and Rectum □ □Extremities and Feet □ □Spine and Musculoskeletal □ □Reflexes □ □

3. This patient

□ has any chronic disease Explain:

□ is on any medication(insulin, dilantin, allergy injections, etc.)

□ is allergic to drugs, medicines, serums, etc.

□ has an allergic condition, which prevents him to take courses such as chemistry, biology, etc.

□ has abnormalities of sight or hearing or both concerned with a school program

□ is limited on sport and physical exercise

4. Immunizations, Laboratory, and X-rays

□ Diphtheria-Tetanus-Toxoid (within 5yrs) □ Chest x-ray

□ Smallpox (within 5 yrs) □ Complete blood count

□ Influenza (recommended) □ Urinalysis

□ Polio (recommended) □ HIV Test

Physician Signature Address Date (mm/dd/yyyy)

of 16Received:_________/__________/__________


Part XIV: Eye Examination

Directions: Please take this form to an ophthalmologist, ask them to complete the required information, and then send it to:




Eye Examination of:Name Date (mm/dd/yyyy)

Ophthalmologist Only I have found the following:

Vision:right eye left eye

Conjuctiva Sclera Vision

Pupils:

Reflexes:

Visual fields:

Nystagmus:

Extraocular Movements:

Fundus:

Additional Findings:

Recommendations:

Signature of Ophthalmologist Date (mm/dd/yyyy)

Address

of 16Received:_________/__________/__________


Part XV: Dental Examination

Directions: Please take this form to a dentist, ask them to complete the required information, and then send it to:




Dental Examination of:Name Date (mm/dd/yyyy)

Dentist Only I have found the following:

Item Present Needed Additional CommentsFillings □ □Extractions □ □Bridges, Crowns, Dentures □ □Condition of Soft Tissues(pyorrhea, sores, bleeding gums, gingivitis, lesions)

□ □

General Condition of Teeth and Indications of Past Dental Care:

Patient has been given the required dental care and his teeth are now in satisfactory condition.

Signature of Dentist Date (mm/dd/yyyy)

Address

of 16Received:_________/__________/__________


Part XVI: Permission for Emergency Medical and Surgical Care

1. It may happen that medical and surgical care is needed. If the candidate is 18 years of age or older, he may admit himself to this service and the superiors will notify his parents unless they have been instructed otherwise by the candidate. If, however, the candidate is under 18, the parents will be notified immediately. Since it can happen that the parents are not available or cannot be reached, we ask that they give to the superiors of the house where their son is resident the permission to act for them and to sign for any permission necessary for medical or surgical care. This is only to safeguard the health of the candidate and to alleviate any anxiety on the part of the family.

2. The contractual form to be completed by parents or guardians giving permission to the superiors of the seminary of the Holy Spirit Seminary where their son resides so that the superiors may act in routine and emergency medical and surgical care on behalf of their son.

I/We:

Parents / Guardianshereby give consent to the superiors of Holy Spirit Seminary to Provide medical and /or surgical care for:

candidate

should said services be deemed necessary or advisable by a duly licensed practicing physician.

Signature Signature

Relationship to Resident Relationship to Resident

Witness Witness

Date (mm/dd/yyyy) Date (mm/dd/yyyy)

3. In case of emergency notify:Name Relationship

( )Address Phone

of 16Received:_________/__________/__________

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