Volunteer in Community Application

Please fill out this form to apply for the 2012 Volunteer in Community program at Holy Wisdom Monastery, which lasts from June 18, 2012 to July 13, 2012.

Start Date*

Dates (two weeks or more) for which you are applying.
End Date*

Dates (two weeks or more) for which you are applying.
Identifying Information
Name*
FirstLast
Address*
Street AddressCityState / Province / RegionZip / Postal CodeCountry
Phone*
Email*
Enter EmailConfirm Email
Birthdate*
Citizenship*
Social Security Number
Relationship Status*
Number of Dependents*
Please enter a value less than or equal to 20.
List two people to notify in case of emergency:*
Name Relationship Telephone Cell Phone Email

Use the + plus sign at right to add more rows.
Education
High School Attended
Year of High School Graduation
College/Technical School Name
College/Technical School - Major
College/Technical School - Graduated?
College/Technical School - Degree
College/Technical School - Year of Graduation
Graduate School Name
Graduate School - Major
Graduate School - Graduated?
Graduate School - Degree
Graduate School - Year of Graduation
If you attend(ed) college but have not graduated, how many semester hours have you completed?
Please enter a value between 0 and 500.
List any courses, studies, work or research in which you have participated that would be relevant to being a Benedictine Sojourner with Benedictine Women of Madison at Holy Wisdom Monastery:
Employment
Name your last two places of employment beginning with your present (most recent) position.
Place of Employment #1
Address #1
Street AddressCityState / Province / RegionZip / Postal CodeCountry
From

Please enter the start date of your present (most recent) place of employment.
To

Please enter the end date of your present (most recent) place of employment.
Position
Place of Employment #2
Address #2
Street AddressCityState / Province / RegionZip / Postal CodeCountry
From

Please enter the start date for this place of employment.
To

Please enter the end date for this place of employment.
Position
Background Information
Religious Affiliation
Have you been active in a church, parish or campus ministry? If so, for how long and in what way?
Please tell us something about your prayer life and ways in which you would like to grow in prayer. *
Please list any other activities related to your religious or spiritual life that you would like us to know (i.e. retreats, seminars, programs).
Please explain any difficulties that you foresee arising from your participation in this program. *
Have you been charged with any illegal activity? If so, please describe briefly and include the outcome of the charge(s).
Skills, Hobbies and Interests
Please list any skills, hobbies, and/or interests that you would bring to this experience of community living and service.
Health History
Please describe the general condition of your health:
Do you have any serious health conditions? *
- No
- Yes
If yes, please explain:
List and explain any physical limitations or handicaps:
List any dietary restrictions:
Are you pregnant or been advised in the last year that hospitalization, surgery or treatment is needed/pending?
- No
- Yes
If yes, please explain:
Check items which currently, or have in the past, caused you concern:
- cancer
- stroke
- heart disease
- alcohol or drug use
- vascular disease
- liver, kidney, lung or intestinal disorder
- mental or emotional disorder
- diabetes
- eating disorder
- epilepsy
- headaches
- arthritis or lupus
- acquired immune deficiency syndrome (AIDS)
- other immune system disorder
- allergies
If yes to any of the above, please explain:
Please list any prescription drugs that might affect your service with us:
Health Insurance Provider
Health Insurance Group #
Health Member Group #
How did you hear about Holy Wisdom Monastery?
Final Steps
Be sure to complete the other two steps for application: 1) A personal letter of intent which can be emailed or mailed to Ann Moyer. 2) Two letters of recommendation.
After you click submit, a copy of your completed application will be emailed to you.