First Name: *

Middle Name:

Last Name: *

Home Address: *

City: *

State: * Alabama Alaska Alberta Arkansas Arizona British Columbia California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Manitoba Maine Michigan Minnesota Missouri Mississippi Montana Nebraska New Brunswick Newfoundland and Labrador New Hampshire New Jersey New Mexico Nevada New York North Carolina North Dakota Northwest Terrotories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming Yukon Other

Zip Code: *

Phone Number: *

Email: *

Major: *

Minor:

High School:

Religious Affiliation: * Anglican Baptist Catholic Greek Orthodox Lutheran Presbyterian Protestant Other Prefer not to answer

Program Name: * Program Descriptions Encountering the Living God, 10-week program

Currently taking a Religious Studies course: * Finding God in All Things (RS) Christian Spirituality (RS) NO

Fairfield ID:

Indicate your status: *

Undergraduate Student - Fairfield Campus

Undergraduate Student - Bellarmine Campus

Graduate Student

Class Year (yyyy)

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

For a spiritual director, do you desire: *   Woman   Man   No Preference  

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

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