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VCMI Personal Biblical Counseling Request Form - 2020
This form is specifically for Personal, Individual, Family or Group Biblical Counseling.
8
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1
Choose Your Campus
*
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Suitland, MD
Bowie, MD
Charles County, MD
Middlesbrough, UK
St. Mary's County, MD
Washington, DC
Woodbridge, VA
Orlando, FL
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2
Name
*
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First Name
Last Name
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3
Are you a member of VCMI?
*
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Biblical Counseling is ONLY available for VCMI Members.
YES
NO
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4
Your Email
*
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example@example.com
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5
Your Phone Number
*
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Area Code
Phone Number
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6
Type of Counseling Requested
Personal/Individual
Family/Group
Personal/Individual
Family/Group
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7
Other Family Member's Name(s) If Requesting family or Group Counseling
First and Last Name
Age
First and Last Name
Age
First and Last Name
Age
First and Last Name
Age
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8
Please describe in detail why you are requesting counseling
*
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