Mentoring Application

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What age range are you in?

50-60 60-70 70-80 80+

Select Gender?

I am willing to commit myself to be a mentor for at least aboute year.

I am willing to commit to check my email ance a day.

I am willing to forward a character reference from my pastor/priest or other Christian leader.

I have read your statement of faith and agree with the basic statements.

Do you use the bible as your standard for life and read it regularly?

Do you struggle with addictions like alcohol, drugs or pornography?

 

Please check the situations below where you feel you could help others.

Abortion

Abuse: Emotional

Abuse: Physical

Abuse: Sexual

Addictions: Drugs and Alcohol

Addictions: Pornography or sexual issues.

Adultery

Broken Family

Chronic illness or pain

Dating

Death and Grieving

Depression

Divorce

Eating Disorder

Parenting

Panic Disorder

Spiritual Growth

Tell us how to get in touch with you:

Name
E-mail
Tel
Cel
FAX
Please contact me as soon as possible regarding the mentoring program.

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Revised: 09/20/11.