Forms

			Coaching Client Application * Required Information

	Name *
	Application Date *		/ / Year Ordained *
	Email Address *		Phone No. *
	Ministry Location *		(Name of Congregation or Institution where you are serving)
	Address Line 1 *
	Address Line 2
	City *		State * Zip *
	Would you like to request a specific coach?		Yes No
	Name of coach requested		(Matching of coaches is dependent on availability)
	Billing Information		The cost for 12 sessions of coaching within a 6-month period is $600.00. Participating synods assume responsibility for a portion of the costs. Pastors are encouraged to contact their synod to determine the amount of their synod's contribution. Pastors receiving coaching, or the congregation they serve are responsible for the remaining amount.
	Snyod/Judicatory contribution *
	Self/Congregation contribution *