Pierced Hearts Mentorship Application

Pierced Hearts Mentorship Application

Please fill out this form to help us learn about you and your needs for personalized faith-centered support. These sessions are meant to offer encouragement, faith-centered guidance, and support for those walking through suffering or difficult seasons of life.
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Age*
City and State*
Occupation or Current Life Stage*
Are you currently involved in a church or faith community?*

YesNo
If yes, which church or parish do you attend?
How would you describe your current relationship with God?*

Very strongGrowingStrugglingUnsure
How important is faith in your life right now?*

Very importantSomewhat importantI am exploring faith
What are you currently walking through in this season of your life?*
When did this situation or struggle begin?*

MonthDayYear
Date
How has this situation affected your life, faith, or relationships?*
What led you to seek mentorship at this time?*
What are you hoping to gain from a conversation with AJ?*
What would a helpful conversation look like for you?*
Would you be open to prayer during the session?*

YesNo
Are there any specific prayer intentions you would like to share?
Have you spoken with a mentor or spiritual guide before?*

YesNo
How did you hear about Pierced Hearts Ministry?
Is there anything else you would like us to know about your situation?
Math Challenge
These sessions are meant to provide encouragement and mentorship rooted in faith. They are not therapy, counseling, or medical advice.
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