Lighthouse Via de Cristo

Candidate Application

Name:________________________________________ Spouse:________________________________

Name you prefer:_________________________ Email-mail Address:__________________________

Home Phone: (      )______________________Spouse’s work phone: (      )_____________________

Address:__________________________________ City:_______________ State:_____ Zip:__________

Birth Date:_________________________ Occupation:________________________________________

Single:________ Married:________ Divorced:________ Widowed:_______ # of Children:_________

Education:____________________________________ Hobbies:________________________________

List any church or civic responsibilities:__________________________________________________

Do you require a special diet? If yes, please explain:______________________________________

List any medical needs you may have:___________________________________________________

Any other information we may need about you?__________________________________________

Church:_______________________________________ Phone No. (      )__________________________

Pastor’s Name:_______________________________ Pastor's Signature:_________________________

Would you like to be contacted by a Lighthouse weekend Spiritual Director? Y (   ); N (   )

If you have made a Cristo weekend please list number and date:_____________________________

Are you able to attend the closing ceremony Sunday afternoon Y (   ); N (   )

Please give a brief account of your applicant’s spiritual condition and contributions or ministries

he/she is involved with:__________________________________________________________________

Lighthouse Via de Cristo, Post Office Box 628, New Smyrna Beach, FL 32170

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