Christian Scientists-in-Residence

Confidential Application

Christian Scientists-in-Residence
Tenacre’s Mission:

"Tenacre Foundation is a Christian Science nursing ministry expressing God, Love

— our mission is to heal"
Tenacre’s Christian Scientists-in-Residence program invites Christian Scientists who are members of The Mother Church to join a Christian community bound by their commitment to the practice of Christian Science and their active participation in Tenacre’s mission and ministries. Tenacre’s resources and supportive environment encourage residents to continue their on-going study and practice of Christian Science as they continue to fulfill their own individual spiritual ministry.

(Please Answer or Notate Each Question)
Name (Mr./Mrs.Miss) *

Prefix First Name Middle Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Cell Number *
Phone Number (Alternate number)
Email
example@example.com
How long have you been a student of Christian Science? *
Are you a member of The Mother Church? *

Yes No
Year joined: *
Are you a member of a branch church? *

Yes No
If so, where?
Have you had class instruction? *

Yes No
What inspires you to continue actively practicing? *
In what ways are you actively engaged in your branch church and how does membership bless your life and community? Active membership in a branch church is a way of expressing our deep gratitude for the teachings of Christian Science. Please share your thoughts about becoming an active member in a local branch church, should you be living at Tenacre. *

Please tell us why you would like to participate as a Christian Scientist-in-Residence at Tenacre. *
In what ways do you feel living at Tenacre would support your desire to live independently and continue your practice of Christian Science? *
We would love to hear about a recent healing you’ve had in the past year. *
What are your current living arrangements? *
Do you require any assistance with your personal care or other services? *

Yes No
If yes, what assistance do you need?
How is this being provided now?
Accommodation Preference: *

Studio 1 Bedroom 2 Bedroom
When would you like to arrive at Tenacre?
Do you plan to use your car at Tenacre? *

Yes No

Person to be contacted in the event of a need or emergency. Please notify them that you have given their name as a contact. *

Name
Address
City	State / Province
Postal / Zip Code	Country

Phone *

Area Code Phone Number
E-mail
example@example.com
Financial Considerations:

A monthly flat-rate charge is billed in advance, and is due by the fifth of the month. This rate will be shown on your signed agreement, and lists amenities included at no additional charge. If the services of a Tenacre Christian Science nurse are needed, the first two hours are complimentary, each day there is a need. You will be billed at the rate of $35 per hour beyond the first two hours.

If you are not handling your own finances, please indicate who will be paying your Tenacre bills and where to send them:

Financial Considerations: *

Name
Address
City	State / Province
Postal / Zip Code	Country

Phone *

Area Code Phone Number
E-mail
example@example.com
Christian Science Practitioner:

It is our expectation that you will be praying for yourself on a daily basis and will be engaging a Christian Science practitioner to work for you as needed throughout your residency at Tenacre.

Important Considerations Concerning Christian Scientists-in-Residence at Tenacre
Please read carefully the following declaration and sign at the bottom of the page. Your signature certifies that you understand and accept the conditions of admission.

• I am a practicing Christian Scientist and rely wholly upon God for healing.

• I understand that Tenacre does not guarantee life care. If I am unable to live independently and wish to be admitted to one of Tenacre’s Christian Science nursing settings, I must apply through Tenacre’s Christian Science Nursing Services’ admission process.

  • I understand that the monthly charges are due by the 5th of each month and will provide for prompt payment of bills, including special services, long distance phone calls, and any special purchases made at my request.

  • I understand that Tenacre is not responsible in any way for my valuables or personal property.

  • I agree to comply within 30 days if Tenacre requests that my stay be terminated or requests that I move to another apartment.

  • I agree to give a 30 day notice if and when I decide to move from Tenacre.

Please sign this application only after carefully reviewing the above considerations. Your signature indicates that the information you have supplied is accurate, that you understand the considerations, and that your desire is to reside at Tenacre and to participate in its mission and ministry.
Applicant's Signature: *
Date:

Month Day Year

Security Addendum
Tenacre is located in a residential setting in Princeton, New Jersey, bordered by private homes and several private schools. It is important to be able to verify that an applicant is free from behavior that is aggressive or harmful to others, or any other behaviors that might interfere with the welfare of the surrounding community.
I affirm that I do not have a history of behavior that is aggressive or harmful to others. *
(Please initial)
Date:

Month Day Year
Please provide the names and telephone numbers of three references who are not related to you, are well-acquainted with you, have knowledge of your behavior in the past, and can describe your demeanor. One should be a Christian Science practitioner.

Reference #1 *

Name
E-mail address
Phone #	City / State
Zip Code	Country

Reference #2 *

Name
E-mail address
Phone #	City / State
Zip Code	Country

Reference #3 *

Name
E-mail address
Phone #	City / State
Zip Code	Country

FAIR CREDIT REPORTING ACT NOTICE AND DISCLOSURE
Tenacre may obtain investigation reports about an applicant in connection with an application for admission into the Christian Scientists-in-Residence program. Tenacre may also obtain such reports at any time during an admitted applicant’s participation in the program. Information gathered through such investigations may be used in determining whether the applicant will become or remain a resident at Tenacre.

An investigation report may include information concerning creditworthiness, credit standing, credit capacity, character, general reputation, personal characteristics, and/or mode of living. Examples of investigation reports include, but are not limited, to criminal background reports, motor vehicle driving records, credit histories, reference checks, verification of education or past employment, and investigations into theft, fraud, harassment and work place violence. This information may be obtained from personal interviews with professional and personal acquaintances. A program applicant has the right to request in writing, within a reasonable period of time, a complete disclosure of the nature and scope of an investigation involving personal interviews.

Because errors can occur, an applicant deemed ineligible for residence as a consequence of an investigation will receive notice of this fact. Tenacre accepts no responsibility for the accuracy of information received from third parties and is under no obligation to test the accuracy of such information before making a decision on admission to the program.

Your signature below acknowledges that you have read and understand the above disclosure.
Signature of Applicant: *
Dated:

Month Day Year
This Notice and Disclosure is made pursuant to the federal Fair Credit Reporting Act (FCRA). The FCRA is designed to promote the accuracy, fairness, and privacy of information maintained in the files of a Consumer Reporting Agency (CRA). Most CRAs are credit bureaus that gather and sell information about consumers – such as whether a consumer pays bills on time or has filed bankruptcy – to creditors, employers, landlords, and other business. Because employee background checks sometimes use information from CRAs, the FCRA is sometimes applicable to employers. The complete text of the FCRA, 15 USC Section 1681-1681u, and a description of a consumer’s right under the FCRA are available at the Federal Trade Commission’s Web site http://www/ftc.gov.

AUTHORIZATION TO OBTAIN INVESTIGATION REPORTS
I,{namemrmrsmiss}, hereby authorize Tenacre to obtain any investigation reports on me in connection with my application for admission into the Christian Scientists-in-Residence program and/or at any time during my participation in the program if I am accepted. I understand that this report will be used to perform a background check which may be used in determining whether I will become or remain a resident at Tenacre.

I have received and read a Notice and Disclosure explaining that such investigation reports may include information concerning my creditworthiness, credit standing, credit capacity, character, general reputation, personal characteristics, and/or mode of living. This information may be obtained from personal interviews with professional and personal acquaintances.

I understand that Tenacre and its agents are not responsible for the accuracy or completeness of the information contained in any such reports. I release Tenacre and its agents from all liability, claims, and lawsuits with respect to the information obtained from any or all of the sources used by Tenacre.

I understand that this authorization is not an offer of admission to the Christian Scientists-inResidence program and that any false or misleading information I have provided to Tenacre may result in denial or withdrawal of my admission to the program.

I also understand that this authorization is a continuing authorization and will remain valid until such time as I inform Tenacre, in writing, that I wish to revoke this authorization.
Signature of Applicant: *
Dated:

Month Day Year
I would like a copy of a credit report if one is obtained by Tenacre: *

Yes No
Enter the message as it's shown *
Should be Empty:

Important Considerations Concerning Christian Scientists-in-Residence at Tenacre

Security Addendum

FAIR CREDIT REPORTING ACT NOTICE AND DISCLOSURE

AUTHORIZATION TO OBTAIN INVESTIGATION REPORTS