Group Program Application Form

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Please take 5 - 10 minutes to complete this form.

Email *

First Name *

Phone Number *

What are your pronouns? *

How do you identify? *

Lesbian

Gay

Bisexual

Transgender

Questioning

Asexual

Other:

Describe the type of life you desire to live? Be specific. *

What is the single biggest struggle you have in reconciling your faith and your sexuality? Be specific. *

How long have you been working on reconciling your faith and sexuality? *

0-3 months

6 months to 2 years

3 years or more

On a scale of 1-10 how urgent is making peace with your faith and sexuality? 1 means "it will work itself out" and 10 being "if this doesn't work I'll lose myself forever" *

It will work itself out

If this doesn't work I'll lose myself forever

How quickly would you like to see results in reconciling your faith and your sexuality? *

2 - 4 weeks

6 - 8 weeks

9 - 12 weeks

In your own words, what are you desiring to achieve by joining the group program?

Have you tried other programs or counseling to help you with making peace with your faith and sexuality? If so, list them here. *

Is there a friend/family you would like to join you AND who you believe would benefit from this program?

Yes

Maybe

Clear selection

When is a good time to reach you? *

Afternoon

Evening

Weekends

Thank you for completing your application for the Queer Christian Group Coaching Program.

You have been added to the waitlist for our next class.

Submit

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