Counselee Application
Helping people take their next step in knowing Jesus and making Him known
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Age
*
E-mail
*
Confirmation Email
Mobile Number
Home Number
Work Number
Marital Status
*
Married
Single
Divorced
Widowed
Separated
Years Married
Years Divorced
Years Separated
Years Widowed
Number of Children
*
1st Child's Name
1st Child's Age
2nd Child's Name
2nd Child's Age
3rd Child's Name
3rd Child's Age
4th Child's Name
4th Child's Age
5th Child's Name
5th Child's Age
6th Child's Name
6th Child's Age
7th Child's Name
7th Child's Age
8th Child's Name
8th Child's Age
9th Child's Name
9th Child's Age
10th Child's Name
10th Child's Age
Back
Next
Counselee Application
Helping people take their next step in knowing Jesus and making Him known
How did you hear about our lay-counseling ministry?
*
How long have you been attending First Baptist Church?
*
Are you a member of First Baptist Church?
*
Yes
No
Have you made the decision to follow Christ and make Him Lord of your life? (Yes/No or explain):
*
Yes
No
Other
What are your available times for lay-counseling? (days/times)
*
Are you currently seeing a professional counselor?
*
Yes
No
If yes, who:
Please describe the reason you are seeking lay-counseling at First Baptist Church:
*
Enter the message as it's shown
*
Submit
Print Form
Should be Empty: