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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 $800.00. Participating synods assume responsibility for a portion of the cost. Pastors are encouraged to contact their synod to determine the amount of their synod’s contribution. Pastors and/or congregations are responsible for the remaining amount. You may also contact Clergy Coaches if you would like to apply for a Scholarship.
Snyod/Judicatory contribution *
  
Self/Congregation contribution *