Certified Single Program Application

Certified Single Program Application

Where wholeness is our priority.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender*
Are you unmarried*
Are you a partner or member at Center for Manifestation?*
If not, which church are you affiliated with:
How did you hear about Certified Single?*
How would you describe your current relationship with God?*
What specific goal, area of growth, or breakthrough are you hoping to experience through the Certified Single Program?*
Would you be interested in being assigned an advisor/accountability partner?
Program Investment Agreement
The total investment for the Certified Single Program is $250. A non-refundable deposit of $50 is required to secure your seat. Payment plan options and scholarships are available and will be discussed directly with applicants during your call with a member of the program team.
Do you acknowledge and agree to these terms?*
We would like to schedule a brief call with you to share more about the program and answer any questions.
Please provide three available dates and times within the next two weeks.*
Should be Empty: