Soul Care/Pastoral Counseling Request Form

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We deeply desire to provide the best care for all of our students. We are grateful for the opportunity to potentially partner with you and carve out some time to help you process what you are needing, the resources & services our campus provides, possible next steps, discernment and prayer if desired.

Note: Your privacy is very important to us. The information you enter in this form will be viewed in complete confidentiality by our University Pastors, and only shared with others if you deem it helpful to do so.

Email *

Full Name (& preferred name or pronouns if applicable) *

Email address *

How long have you been a student at Fox (including current semester) *

Less than 1 year

2 years

3 years

4 years or more

Required

Could you please briefly describe why you are seeking Soul Care &/or counseling with the SpiL Office? *

What are your meeting preferences? *

In-person meeting(s) in the SpiL/Barclay House offices

Virtual meeting(s)

In-person meeting(s) outside of SpiL/Barclay House or off-campus

Female Pastor

Male Pastor

Any Pastor (No preference)

Required

Which of the following have you received/experienced before:

Pastoral Counseling

Spiritual Direction

Psychotherapy or mental health counseling

Mentorship or Life Coaching

Premarital or Marriage Counseling

None

Which of the following best describes what you believe you are seeking now?

Pastoral Counseling: can involve difficulties, questions, problems or crises of various kinds (faith, relationships, beliefs/doubt, etc.)

Spiritual Direction: a deep, wise and loving person befriending your spiritual journey for the long run

Premarital or Marriage Counseling: preparation/support for a healthy longterm committed relationship

Mentorship: experienced support for particular goals one is trying to achieve

Mental Health counseling/therapy: MH assessment, diagnoses, treatment plan, etc

Clear selection

How would you currently describe your spiritual or religious identity and core beliefs? (Please say as much as you would like to describe)

What religious or spiritual activities/practices are important to you daily? Weekly? Monthly? Annually? (Don't worry about perfect involvement/attendance to include descriptions).

How would you describe your childhood, your family of origin, and how you were raised?

Did someone refer you to meet with a University Pastor?

What are you most proud of about yourself?

Spiritual Life Soul Care / Pastoral Counseling

Policy & Consent:

Soul Care/Pastoral counseling typically ranges from once to twice a month, and will be re-evaluated every semester. Spiritual Direction & mentorship can be an ongoing relationship for the appropriate duration that Spiritual Director and student deem a fit for their journeys.

The Office of Spiritual Life is dedicated to helping students get connected to any and all resources that might be beneficial to their health and wellbeing. Should additional or other specialized support become more obviously helpful, during or after the first five appointments, we will connect you to other University resources. It is our desire to support you as best we can and we are grateful for the opportunity to join you in your commitment to wholeness, growth and maturity.

GFU Pastors are able to have confidential conversations with students within the Soul Care/pastoral counseling setting. By providing your consent to receive Soul Care/pastoral counseling, you are expressing an understanding that we will hold all your information confidential except under the following conditions:

- threat/harm to a minor

- threat/harm to a dependent adult/elder

- threat to harm Self or others

Under these circumstances, we will immediately work with you towards the next steps in enlisting support of other professionals for your safety and for the safety of others.

Additionally, instead of meeting with a pastoral counselor, you may be referred to be paired with another Spiritual Life staff member or vetted, local ministry professional who offers Spiritual Direction or experienced spiritually formative conversations & prayer. Spiritual Direction provides a space for processing life, listening to the spiritual movements in a person's life together, prayer, and a commitment to unconditionally befriending your ongoing wholeness and spiritual growth.

(Note: Spiritual Life staff and vetted local ministry professionals do not hold the exact same confidential privileges as our University pastors). All GFU staff members are mandated reporters and are obligated to report any & all threats of harm to self &/or others as well as other issues related to campus standards and policies. If you are paired with a Spiritual Life staff member who offers space for spiritual guidance conversations, you will be notified via email and can accept or decline the meeting. If you decline the meeting, you will then be paired with a University Pastor as soon as they are available.

Do you consent to the policies and conditions listed above in regards to receiving pastoral counseling?*

Yes

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