Appendix B-2 PASTORAL INSTITUTE ♦ DIOCESE OF BROOKLYN LAY MINISTRY PROGRAM Type in Boxes PARTICIPANT CHANGE IN PROGRAM INFORMATION FORM Name: ____________________________________________________________ Title
First Name
Middle Initial
Last Name
Year Expected to be Commissioned: ______ Class Location: _________________ Please print clearly any changes to your information below.
Change in Mentor Name of New Mentor: _______________________________________________ Reason for Change: _________________________________________________
_____________________________ Participant’s Signature and Date
_____________________________ Pastor’s Signature and Date
Change in Class Location I request that the location of my classes be changed to: ___________________________ This change is (check one):
Permanent
Temporary until ____________________
Reason for change:
_______________________________ Participant’s Signature and Date
______________________________ Pastoral Institute Signature and Date
Withdrawal from Program I must withdraw from the Program. This withdrawal is (check one): Permanent Temporary
_____________________________ Participant’s Signature and Date
______________________________ Pastor’s Signature and Date
__________________________________
______________________________
Mentor’s Signature and Date Pastoral Institute Signature and Date Please return by MAIL, FAX or EMAIL to Pastoral Institute, 310 Prospect Park West, Brooklyn NY 11215; FAX: (718)399-5920; EMAIL:
[email protected]. For questions, please call (718) 965-7300.
Participant Handbook
