Stephen Minister Application
Beautiful Savior Lutheran Church
Stephen Minister Application – CONFIDENTIAL
Fortifying Faith  Selfless Service  Engaging Others
Thank You for your interest in becoming a Stephen Minister with Beautiful Savior Lutheran Church (LCMS) of Lee’s
Summit, Missouri. The Stephen Ministry program is a distinctly Christian, formally trained, lay ministry for the purpose of
serving hurting members within our congregation and as an outreach ministry to the community.
As a Stephen Minister, all levels of your participation and commitment should reflect the principles of the Care Giver’s
Compass by being: Compassionate, Trustworthy, Full of Faith and Skilled. Please review the Stephen Minister Job
Description, and 2010-2011 Training Schedule, which have been included in this packet.
As a Stephen Minister you commit to the following:
1) Attending 50 hours of initial training for distinctly Christian lay ministry;
2) Acceptance of a care receiver(s) and meeting with that care receiver, one-to-one, one time weekly;
3) Upholding strict confidentiality in regard to your communications with your assigned care receiver according
to Stephen Ministry guidelines; and,
4) Attending Bi-monthly Peer Supervision / Continuing Education meetings, once the initial training has ended.
After prayerful contemplation and review of the attached information, please complete the following forms and return all
requested items, in the provided confidential envelope (may be dropped off at the church office) to the attention of:
Jill Dukes, Stephen Leader, at Beautiful Savior Lutheran Church:
1) Stephen Ministry Application;
2) Stephen Minister Job Description (signed);
3) Missouri Department of Health & Senior Services Family Care Registration Form (check ‘Voluntary
Registration’, Section A);
4) Check made payable to Missouri Department of Health and Senior Services for $10; and,
5) A color copy of your Social Security Card
Your Application and Background Check Screening will be reviewed by the Stephen Leader team made up of Jill Dukes,
Jack Volz and Pastor Nathaniel Schwartz. All application information will remain strictly confidential within the Stephen
Leader Team. You will be contacted to set up an initial interview with Jill Dukes after your application has been reviewed.
For those who wish to type their application responses, the Stephen Ministry Application can be emailed to you in Word
Document format by contacting Jill Dukes, at 816-507-6900 or via email at: jdukes.bslc.stephens@gmail.com. Please
direct any questions you may have to Jill Dukes.
Thank You for Considering Serving Others in the Name of Our Lord and Savior, Jesus Christ!
Jill Dukes
Stephen Leader
Beautiful Savior Lutheran Church
“Bear one another’s burdens, and in this way you will fulfill the law of Christ.”
- Galatians 6:2
Copyright © 2000 by Stephen Ministries, St. Louis. All rights reserved. Permission to make copies of this document is given ONLY to enrolled Stephen
Series congregation and ONLY for use within the enrolled congregation. Adapted for use by Beautiful Savior Lutheran Church, Lee’s Summit, MO., by
permission, 2010.
Stephen Minister Application
1) Personal Information
NAME
Email ADDRESS
STREET ADDRESS
CITY / STATE / ZIP
Home PHONE
Cell PHONE
DATE OF BIRTH
OCCUPATION
Have you been previously trained as a Stephen Minister? Please check all that may apply.
 Yes, in this congregation
 Yes, in a different congregation...Please state the congregation’s name and location
 Yes, but it has been a while since I served as a Stephen Minister, and would like to review the training.
 No, I did not complete the full training.
 No, I have never received training or attempted the training.
2) How are you currently serving or participating in the ministry opportunities at Beautiful Savior Lutheran Church?
Check all that may apply to you:
 Elder
 Trustee
 Bible Study – Sunday Morning
 Bible Study – Wednesday Night
 Bible Study – Other, please list day of week:
 MOPS
 Senior Citizens in Action (SCIA)
 Upward Basketball
 Small Group
 Board Member – Please list Board you serve on:
 Usher / Greeter
 Youth Ministry
 Sunday School
 Wednesday Night Ministries
 PreSchool
 Contemporary Worship Team
 Other (please list):
List any other volunteer or paid ministry programs or opportunities in which you participate or serve this congregation.
Describe your role and/or level of participation (frequency of participation, e.g. daily, weekly, monthly, etc.).
3) Describe why you are interested in becoming a Stephen Minister.
Copyright © 2000 by Stephen Ministries, St. Louis. All rights reserved. Permission to make copies of this document is given ONLY to enrolled Stephen
Series congregation and ONLY for use within the enrolled congregation. Adapted for use by Beautiful Savior Lutheran Church, Lee’s Summit, MO., by
permission, 2010.
Stephen Minister Application
4) What spiritual gifts or strengths do you believe God has given you that would help you serve effectively as a Stephen
Minister?
5) In what ways do you think you would benefit personally from your training and service as a Stephen Minister?
6) Based on your current understanding of what it means to be a Stephen Minister, what do you think would be the
difficult or challenging aspects of this role for you?
7) How would people who know you describe the way you relate to others?
Copyright © 2000 by Stephen Ministries, St. Louis. All rights reserved. Permission to make copies of this document is given ONLY to enrolled Stephen
Series congregation and ONLY for use within the enrolled congregation. Adapted for use by Beautiful Savior Lutheran Church, Lee’s Summit, MO., by
permission, 2010.
Stephen Minister Application
8) Are you willing to commit to serve faithfully for an estimated period of no less than two years? This would include:
• Initial 50 hours of training – A beginning partial-day retreat, mid-term partial-day retreat, and 15 Thursday
evening training sessions (6:30 -9:00pm), 09/11/10 thru 02/03/11.
• Regular visits to your Care Receiver (estimated weekly or a mutually agreed-upon frequency); and
• Twice-monthly Small Group Peer Supervision / Continuing Education Meetings (1 hour, 30 minutes)
 YES
 NO
What changes would you need to make in your life in order to fulfill this commitment?
9) Describe your relationship with Jesus Christ.
10) Please provide three references, two of which are NOT members of this congregation.
NAME (1) – NON MEMBER
RELATIONSHIP
ADDRESS
PHONE
NAME (2) – NON MEMBER
RELATIONSHIP
ADDRESS
PHONE
NAME (3)
RELATIONSHIP
ADDRESS
PHONE
Copyright © 2000 by Stephen Ministries, St. Louis. All rights reserved. Permission to make copies of this document is given ONLY to enrolled Stephen
Series congregation and ONLY for use within the enrolled congregation. Adapted for use by Beautiful Savior Lutheran Church, Lee’s Summit, MO., by
permission, 2010.
Stephen Minister Application
11) Have you ever received or are currently receiving treatment for any emotional or psychiatric problem?
 YES
 NO
If yes, someone from the Stephen Leader Team will speak with you about this so that the team may better understand its
significance in your life and ministry.
Note: A great many caregivers have been made stronger in their care-giving ministry through the care they themselves
have received, including care from mental health professionals. Your Stephen Leader Team affirms the work of mental
health professionals, who have helped many individuals to experience growth and healing. Members of the Stephen
Leader Team request this information because they want to be as fully informed as possible about their Stephen
Ministers, and when making Stephen Minister assignments to a care receiver.
Copyright © 2000 by Stephen Ministries, St. Louis. All rights reserved. Permission to make copies of this document is given ONLY to enrolled Stephen
Series congregation and ONLY for use within the enrolled congregation. Adapted for use by Beautiful Savior Lutheran Church, Lee’s Summit, MO., by
permission, 2010.
Stephen Minister Application
12) Have you ever been charged with a crime? (Felony or Misdemeanor).
 YES
 NO
If yes, explain in detail, using additional paper as needed. Someone from the Stephen Leader Team will speak with you
about this so that the team may better understand its significance in your life and ministry.
Note: Beautiful Savior Lutheran Church requests that all potential Stephen Ministers fill out the State of Missouri
Department of Health & Senior Services Family Care Registration Form (check ‘Voluntary Registration’, Section A) for the
purpose of Background Check Screening. It is important from a congregational and personal liability standpoint, that
Stephen Ministers, in light of meeting one-on-one, and many times in the individual’s home (un-witnessed) that all
precautions have been taken to prevent potential abuse allegations. This procedural decision supports the congregation’s
commitment to the provision of skilled and screened lay ministry for all care receivers.
STEPHEN MINISTER APPLICANT - VERIFICATION OF INFORMATION, COMMITMENT AND CONSENT STATEMENT
PLEASE READ AND SIGN BELOW:
The information I have provided in this application is true and complete to the best of my knowledge. I agree to participate
in Stephen Ministry training and in Small Group Peer Supervision/ Continuing Education and to function within the
boundaries of Stephen Ministry as adopted by Beautiful Savior Lutheran Church, LCMS, Lee’s Summit Missouri. I give
permission to the Stephen Leaders of Beautiful Savior Lutheran Church to call my references, secure a Family Care
Registry / Criminal Background Check on me, and consult with the treating physician(s) or other mental health
professionals regarding the nature of any treatment I have received, or am receiving, for emotional or psychiatric issues.
Signature of Stephen Minister Applicant
Date
Thank You for completing this application and your willingness to care for and share the burdens of
others as a servant our Lord and Savior Jesus Christ.. Jill Dukes, Stephen Leader, will be contacting
you as soon as this application (including background check) has been reviewed by the Stephen
Leader team, to set up an interview with you.
Copyright © 2000 by Stephen Ministries, St. Louis. All rights reserved. Permission to make copies of this document is given ONLY to enrolled Stephen
Series congregation and ONLY for use within the enrolled congregation. Adapted for use by Beautiful Savior Lutheran Church, Lee’s Summit, MO., by
permission, 2010.