Name *
E-Mail *
Address *
Cell Phone *
May We Call or Text if Necessary? *YesNo
For which Course, Session, or Event are You Applying? Select one. *Strength & Dignity eCourse membership for one yearStrength & Dignity CoachingGreater Impact Conference
If coaching, please give specifics such as group, individual, deeper dive.
Have you participated in any other previous Greater Impact Program? *YesNo
In seeking financial help have you asked for assistance from your Church? Please explain. *
Are you able to pay any part of the enrollment fee? *YesNo
If Yes, How Much?
Best Times to Reach You By Phone (Please Include timezone) *
If you live outside the United States, may we contact you via video call or email? *Not Outside USEmailVideo Call
Please give a detailed description of 1) Your need for financial help. 2) What you hope to gain by attending the program. *
Electronic Signature: Please Type Your Full Name *
Anything Else You Would Like Us To Know?