Coaching Certification Program
A SheRecovery Program | Live Course + Groups | Enroll by September 23, 2025
Full Name
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First Name
Last Name
Phone Number
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Can you receive texts on this phone number?
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Yes
No
E-mail
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Confirmation Email
example@example.com
Address to ship 90 Days to Wholeness paperback (ships to United States and Canada only). Allow up to 14 days for delivery.
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Application
Please Describe Your Role(s)
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Coach
Counselor
Student (College)
College Leader
Church Leader
Lay Church Leader
Ministry Leader
Other, please define
What was your highest level of education attained?
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High school diploma or GED
Some college
Associate degree
Bachelor's degree
Master's degree
Professional degree
Doctorate
Other, please define
Please select your age range:
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18-24 years old
25-34 years old
35-44 years old
45-54 years old
55-64 years old
65-74 years old
75 years or older
Are you currently or have you ever been in recovery yourself?
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Yes
No
I prefer not to say
Please briefly describe why you are seeking this certification and what you hope to achieve with it?
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What questions would you like to have answered by this certification program? Your questions may help to shape some of the content, so it is good to ask!
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What are some of your concerns or insecurities about being a part of this certification program?
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Since this is a faith-based training, please describe your own faith. What is your relationship with God like? In what ways have you/do you use your faith in service to others? If not applicable, please type N/A.
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Is there anything else you would like to add?
Terms & Agreement
By submitting this application you are agreeing to the following terms. Please read carefully and check the individual boxes to agree to the terms.
I agree to all terms as outlined below:
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I understand the required live course will take place on Tuesday, September 30, 2025 from 11:00am-4:00pm CDT (includes 30 minute break).
I understand that each process group will be 2 hours in length held October 14, October 28, November 11, November 25, December 9, and December 23 at 7:00pm CDT. Adjustments to the schedule will be communicated with adequate warning.
I understand that if I am unable to attend the live course and all process groups, I may forfeit my certification and without refund. If extenuating circumstances apply, they will be considered on a case by case basis.
I understand much of this course is shared from a faith-based (Christian) perspective.
I understand that men are welcome to take this course, it is not advised that men work individually with women.
I understand no CEUs will be awarded for participating in this program though a certificate of completion will be provided.
I understand since this is a pilot program, it is not yet accredited.
Payment & Payment Plans
Select Payment Plan
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Pay in 4 Payment Plan (Biweekly)
Payment 1 of 4 due now, and then autopay every two weeks.
$
225.00
Pay in Full
Payment due in full now.
$
900.00
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