Title: - Select - Mr. Miss Ms. Mrs. Father Sister Rev
*First Name:
*Last Name:
Honorific (SJ,FCJ):
Birth Date: 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Company Name:
*Gender: Male Female
Marital Status: - Select - Single Married Widowed Other
*Religious Denomination:
*Address:
*City:
*Province/State:
*Postal/Zip Code:
*Country:
Work Phone:
*Home Phone:
Cell Phone:
Fax:
Email:
Is this a new address or phone number?: Yes No
Please identify the Loyola House program and date for which you are applying:
Program Name:
Calendar Date:
Please select a start date:
Please select an end date:
If the program is filled: Cancel my application Place my name on a waiting list Apply my name to another program
It is the responsibility of Loyola House to provide qualified directors for its retreatants. In order to help us assign the right spiritual director for your request, please respond to the following questions:
What qualities would you like in a director:
What are your personal reasons for making this retreat: Silence and prayer Ignatian spirituality Personal Growth Rest and relaxation
Have you been to Loyola House before: Yes No
Have you attended a directed retreat before: Yes No
Are you accustomed to a totally silent retreat: Yes No
Other Information that would be helpful for us to know:
Have you attended the Spiritual Exercises of St.Ignatius: Yes No
How did you first hear about Loyola House: -- Select -- Family/friend/community Internet Advertisement
Occupation:
Spiritual Ministry (if applicable):
Highest education level: -- Select -- High School College Undergraduate Masters Ph.D
Income: -- Select -- $20k and under $20k-$30k $30k-$40k $40k-$60k $60k and over
Comments:
All information received will be maintained in the strictest confidence and no data will be sold, distributed or in any other way communicated to individuals or organizations not directly related to Ignatius Jesuit Centre.
All fields marked with an " * " are required.
Examples of Religious Denomination: Catholic, Anglican, Baptist, United, etc.
