Program Registration for Adult * items required

First Name: *

Middle Name:

Last Name: *

Home Address: *

City: *

State: *

Zip Code: *

Phone Number: *

Email: *

Program Name: * Program Descriptions

Religious Affiliation: *

Fairfield ID:

Education Background:

School:

Brief Bio (4000 char limit):

What stirs your desire for this spiritual journey? (4000 char limit):

Indicate your status: *

Fairfield University Alumni	Undergraduate	Undergrad Class Year(yyyy)
	Graduate	Grad Class Year(yyyy)
Non Alumni	Faculty/Staff	Off-Campus Resident

What is your gender preference for a spiritual director: * Woman Man No Preference

Would you like to meet: * In-Person Zoom No Preference

Check off the days you would prefer to meet: Monday Tuesday Wednesday Thursday Friday No Preference

Tell us how you heard about our program:

If you would like to refer a friend, please provide their name and email here:

Name:

Email:

*For question, please contact our administrative office at (203)254-4000 ext 3468
**Applicants who are employees of Fairfield University or Fairfield Prep are not expected to make any type of remuneration for our services.

The Murphy Center For Ignatian Spirituality of Fairfield University
Dolan House
1073 North Benson Road
Fairfield, CT 06824
Email: mcis@fairfield.edu
Website: www.fairfield.edu/mcis
Phone: (203)254-4000 ext 3468

Murphy Center For Ignatian Spirituality Adult Program Registration

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Murphy Center For Ignatian Spirituality Adult Program Registration

Please wait while your request is being processed.You will be forwarded to the confirmation page soon.

Please wait while your request is being processed.
You will be forwarded to the confirmation page soon.