Catholic Gap Year Program Application

If we can assist you in any way during your application process, please contact Rebecca Skuban, Applications Coordinator.

(Note: If you are a St. Therese alumni and would like to apply for the Mission Year Program, please use the Mission Year Program Application Form).

Catholic Gap Year Program • Application Form

"*" indicates required fields

Step 1 of 4

"Getting to Know" You Questions

Work & Volunteer Experience

Places that you've worked, with dates.

Please list your past employment – eg. Joe's Pizza House (summer 2015 and 2016), John's Auto Repair (May 2016-present)

Places of Volunteer (with Dates).

Please list your past volunteer opportunities -- eg. Youth Group leadership team (2013-present), VP on High School Student Council (2014-2015), Food Bank (Dec. 2014 & 2015)

Personal Assessment

1) I willingly accept direction, correction and advice.**

2) I show patience and tolerance of differing viewpoints.**

3) I show perseverance to fulfill commitments and responsibilities.**

4) I desire to grow, and am open to new ideas and ways of doing things.**

5) I possess a cooperative and friendly attitude.**

6) In terms of academic studies, I manage my time well to complete assigned tasks and I am able to comprehend topics taught in a lecture style and communicate my reflection/opinion/thoughts on a specific topic both verbally and in written form.**

From the above, please elaborate on one strength.**

From the above, please elaborate on one area in which you need to grow.**

Physical and Mental Health

This following section on Physical and Mental Health is optional. We ask these questions so as to be able to offer you the best advise and direction as you discern if the Nine-Month Formation Program at St. Therese Institute is the place where God is calling you at this time.

We want all people to find the wholeness that God desires for them in their lives and, occasionally, an applicant may be dealing with an issue that is beyond our ability to properly support them in. We've been able to recommend other programs that are a better fit for what they uniquely need right now, and on request can transfer their application forward to a future year.

1) Are you seeing a doctor/specialist on a regular basis for a specific condition(s)?

Yes

Please explain

2) Are you presently taking any prescription medication?

Yes

2) Are you presently taking any prescription medication? - Please explain

3) Do you have any allergies?

Yes

3) Do you have any allergies? - Please explain

Please Note: Our kitchen is able to accommodate Gluten and Dairy intolerances. We recommend discussing other food allergies or sensitivities with our Admissions Department prior to applying to see if we are able to properly accommodate your individual needs.

4) Do you presently have any injuries, disabilities, or other health concerns that you feel might impact your ability to fully enter into the academic or community/social dimensions of the program?

Yes

4) Do you presently have any injuries, disabilities, or other health concerns? - Please explain

References

Three (3) people will need to submit confidential reference forms on your behalf to complete of the application process. The following may help you decide who to approach for a reference:

REFERENCES CRITERIA:
Each reference person should be: 1) someone you have known for more than six months; 2) who knows you well; 3) is objective; 4) has been in contact with you within the last year, and; 5) not related to you.
SUGGESTED REFERENCES: parish priest or pastor; prayer or youth group leader; employer or supervisor; teacher or professor; or, another individual that knows you well and will provide an honest & objective referral. INADMISSIBLE REFERENCES: immediate family members, other close relatives, roommate, personal friends.
If in doubt about an reference's suitability, please contact us!

Reference #1

Do you know who this reference will be?

Not yet

Yes

Ref#1 Name*

Ref#1 Email

Ref#1 Phone

Ref#1 How Do They Know You*

Reference #2

Do you know who this reference will be?

Not yet

Yes

Ref#2 Name*

Ref#2 Email

Ref#2 Phone

Ref#2 How Do They Know You*

Reference #3

Do you know who this reference will be?

Not yet

Yes

Ref#3 Name*

Ref#3 Email

Ref#3 Phone

Ref#3 How Do They Know You*

Contacting Your References

It is YOUR responsibility to contact your reference and provide them with the Confidential Reference Form link or PDF.

Each reference will submit the completed Reference Form back directly to us.

ONLINE REFERENCE FORM: option 1) Use the "Prepare a Confidential Reference Form" tool to create a link to send to your references. You will have the option to pre-enter select fields on the form (eg. your name, their name and contact info)
option 2) Ask your references to visit www.St-T.ca/STIRefForm. This will be a blank copy of the reference form without any information pre-filled. .

PDF REFERENCE FORM: Visit www.St-T.ca/STIRefForm to find a link for downloading a printable / emailable PDF or Word-DOCX version of the reference form.

Catholic Gap Year Program Application