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?