Power HEAL Interest Form
Complete this form for an opportunity to be invited into our 6-week Collaborative Healing Coaching
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Do you meet all the requirements to apply? 1. I am no longer in an abusive relationship or marriage 2. I have children with the abuser 3. I have an active family court case 4. I am financially capable of investing in my healing
*
Yes
No
What has happened in the last 6-months that caused you to seek healing? Ex:(This situation is on-going with no resolution or I'm fresh out of the relationship and I'm struggling to manage)
*
Are you comfortable sharing your story with 6 other qualified women who are experiencing similar issues?
Yes
No
What outcome are you expecting during the 6-weeks?
Are you comfortable learning biblical principles to assist in the healing process? Why or why not?
Submit
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