Primary Contact

First Name*

Last Name*

Email Address*

Phone Number

Title / Role* (Bishop, Superintendent, Director, etc.)

Denomination / Organization Details

Denomination or Network Name*

Department or Division (if applicable)

Website

Regions Served (for example: Southeast US, National, Global)

Scope of Request

What are you interested in exploring?*

Clergy mental health training for your district / conferenceLeadership training for pastors and staffCounseling ministry planning across multiple churchesKeynote / plenary sessions for denominational eventsOngoing consultation or partnershipCustom curriculum or certificate program

Estimated number of churches or sites involved

Estimated total number of participants

Format and Timeframe

Preferred delivery format* (Click the Dropdown)
In-person regional gatheringsVirtual cohortsBlended modelNot sure yet

Desired timeline or event window

Goals and Outcomes

What are your main goals for this training or partnership?* (Click the Dropdown)

Budget and Decision Process

Approximate budget range (if known) (Click the Dropdown)
Not sure yetUnder $5,000$5,000–$10,000$10,000–$25,000Over $25,000

Who will be involved in the decision?* (Click the Dropdown)
I am the primary decision makerI am gathering information for a committeeI am recommending options to leadership

Next Steps

Preferred way to connect for next steps* (Click the Dropdown)
Email follow-up30-minute discovery call

Any additional details or questions

Please send me more information about denominational or enterprise-level partnerships.

Δ