Counselee Application
Helping people take their next step in knowing Jesus and making Him known
Name
*
First Name
Last Name
Address
*
Street Address
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Age
*
E-mail
*
Confirmation Email
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Format: (000) 000-0000.
Home Number
Format: (000) 000-0000.
Work Number
Format: (000) 000-0000.
Marital Status
*
Married
Single
Divorced
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Years Married
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Number of Children
*
1st Child's Name
1st Child's Age
2nd Child's Name
2nd Child's Age
3rd Child's Name
3rd Child's Age
4th Child's Name
4th Child's Age
5th Child's Name
5th Child's Age
6th Child's Name
6th Child's Age
7th Child's Name
7th Child's Age
8th Child's Name
8th Child's Age
9th Child's Name
9th Child's Age
10th Child's Name
10th Child's Age
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Counselee Application
Helping people take their next step in knowing Jesus and making Him known
How did you hear about our lay-counseling ministry?
*
How long have you been attending First Baptist Church?
*
Are you a member of First Baptist Church?
*
Yes
No
Have you made the decision to follow Christ and make Him Lord of your life? (Yes/No or explain):
*
Yes
No
Other
What are your available times for lay-counseling? (days/times)
*
Are you currently seeing a professional counselor?
*
Yes
No
If yes, who:
Please describe the reason you are seeking lay-counseling at First Baptist Church:
*
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