Episcopal Diocese of Rhode Island
Application for Licensing as a Eucharistic Visitor
Name: (Please print) ________________________________
Address: ________________________________________
Phone: ________________________
E-mail: _______________________________
CHURCH HISTORY: (please print)
Baptism: __________________________________________________________
Church/City/State/Date
Confirmation: _______________________________________________________
Church/City/State/Date
Present Parish: ______________________________________________________
I understand the following training components are required for licensing as a Eucharistic
Visitor:
A) The Basic Training for Eucharistic Visitor's Course
B) Safe Church Training on-line modules: Your Policies, Abuse Risk Management for
Occasional Volunteers (Speak to your priest for log-on information)
C) Participation in training in my parish under the direction of my Rector/Vicar.
D) Recommendation from my Rector/Vicar upon completion of this training.
Signature: __________________________
Date: ________________
Signature of Rector/Vicar: _____________________
Date: _________________
Please return this application to:
Liz Crawley
Episcopal Diocese of Rhode Island
275 North Main Street, Providence, RI 02903