Ministry Application

Thank you for your inquiry!

This application form will take perhaps 20 minutes to complete if you fill in most fields. The optional fields can help you clarify root issues more quickly if you feel they are important, and also help us gain a better understanding of your life situation. (Only significant highlights are needed, not your entire life story.)

Please note that field labels with an (R) are required (only name, email and session preferences). Information is kept private and not used for any other purpose.

The "Finish" button to submit the application is located at the bottom of the last page (Step 5, Significant Past Events).

Please enter your first name (R)

Your last name (R)

Your email (R)

Your most easily reached telephone:

Your Country:

Your biological gender:

Male

Female

Your age:

Your marital status:

Your Occupation:

What is your preferred appointment day(s), Mondays through Thursdays? (R)

Describe the atmosphere growing up in your family of origin:

Describe your childhood relationship with your father:

Describe your childhood relationship with your mother:

Describe your childhood relationship with your siblings:

Briefly describe any significant past events:

Any significant events at school / college?

Any significant sickness, injuries, hospitalizations?

Any significant physical challenges?

Any significant regrets / failures?

Any significant deaths?

Any emotional / verbal abuse?

Any physical or sexual abuse?

Any significant relational / marital issues?

Have you or anyone in your family had drug, alcohol or other addictions?

Have you or your family had any occultic involvement?

Do you have any other questions?

Thank you for taking the time to complete the application.

Our desire is to be as warm and personal as possible. However, those in helping professions need to satisfy the legal requirements of informed consent.

By submitting your application, you are acknowledging that you have read and accept the legal waivers at this link. (This will open in a new window, which you can close when finished, before clicking the "FINISH" button below.)

Personal Prayer Ministry

Changing the world
one person at a time…

Personal Prayer Ministry

Changing the worldone person at a time…

Changing the world
one person at a time…