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* 1. Name

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* 2. Email 

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* 3. Faith tradition/denomination (present and past)

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* 4. Current congregation/faith community membership

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* 5. Ordained? 

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* 6. Pastoral experience or other life experience you think would be helpful as a Spiritual Care Volunteer:

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* 7. Briefly state why you are hoping to become a Spiritual Care Volunteer at this time:

Required Commitments:

The following commitments are required of all volunteer chaplains who minister at Inova Alexandria Hospital or Inova Mount Vernon Hospital.  If not met, could lead to review and possible dismissal from the program.

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* 8. Spiritual Care volunteers work with all people.  I will minister to all patients and staff members of all faith traditions as well as those of no faith tradition.

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* 9. Spiritual Care volunteers respect the faith traditions of others, especially the sick and vulnerable. I will never proselytize staff, patients, or family members either directly or indirectly.

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* 10. I will maintain and protect the confidentiality of patients, visitors and staff.

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* 11. I will act in accordance with the policies and procedures of Inova and the Spiritual Care Department.

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* 12. I will adhere to the compliance requirements of the hospital volunteer department as part of my onboarding and ongoing participation in the program.  

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* 13. I will serve a minimum of 4 daytime/evening hours per week and one overnight shift per month. If you have extenuating circumstances that prohibit night duty, please indicate here.

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* 14. Please list the times and days when you would be available for duty each month:

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