Brave Disciple Program Application

1

Do you identify as a Christian?* This field is required.

Yes

No

Prefer not to say

2

How long have you been struggling with pornography?* This field is required.

Less than 1 year

1-3 years

3-10 years

10+ years

3

How often are you currently viewing pornography?* This field is required.

Daily

Several times a week

Once a week

A few times a month

Less than once a month

4

What have you already tried to quit?* This field is required.Select all that apply

Free apps

Paid apps like Covenant Eyes

Accountability partner or friend

Pastor or counselor

Therapy

Support groups

Nothing yet

5

In your own words, why do you want to be free from this struggle?* This field is required.

6

Are you willing to have your devices locked down with monitoring and restrictions controlled by our team?* This field is required.

Yes

No

Unsure

7

Are you willing to be fully honest with your accountability partner, even when you fail?* This field is required.

Yes

No

8

Can you commit to regular check-ins and action steps for at least 90 days?* This field is required.

Yes

No

9

Does it sound helpful to have not only 90 days of close accountability, but also a full year of protected devices as you continue to walk this out?* This field is required.

Yes, that sounds exactly like what I need

I am not sure yet

Unsure / I'd like to hear more

10

Brave Disciple is not an app subscription. It is a 90-day process where a dedicated accountability partner walks with you, helps lock down your devices, and holds you to the commitments you make. This requires a serious commitment of time, effort, and finances. Does that describe you in this season?* This field is required.

Yes, I am ready to invest seriously in my freedom

I want help, but I am limited financially right now

I am just exploring options

11

When you consider what staying stuck in this struggle costs you spiritually, emotionally, and relationally, how willing are you to invest financially in an accountability partner who walks with you for 90 days?* This field is required.

I am willing to invest significantly if I believe this will truly help

I am willing to invest something, but it would need to be modest

I am not willing or able to invest financially right now

12

How serious are you about locking down your devices?* This field is required.

I would like to keep my existing phone with strong restrictions

I would consider using a separate preconfigured Brave Disciple iPhone if it meant fewer loopholes

I am not ready for strong device restrictions

13

Email Address* This field is required.

example@example.com

14

Phone Number* This field is required.

Please enter a valid phone number.

15

Age* This field is required.