Abundant Life Christian Center

Raising Winners, Possessing Nations
APPLICATION FOR COUNSELING
  1. First Name*
    Please type your First Name
  2. Last Name*
    Please type your Last Name
  3. E-mail*
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  4. Telephone*
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  5. Gender*
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  6. What is your relationship status?
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  7. If married, do you live with your spouse?
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  8. Are you a member of ALCC?*
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  9. If not a member, name of your home church
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  10. Are You Born Again?
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  11. Do you attend church regularly?*
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  12. If born again, when?
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  13. Please describe the purpose of your visit*
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  14. Note: Due to the busy schedule of the Senior Pastors, they reserve the right to refer your appointment to any associate pastor or ordained leader.
  15. Who would you like to see during this appointment?*
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  16. Have you had previous counseling?*
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  17. If you have had previous counseling, with whom?
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  18. Duration of Counseling?
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  19. Reason for Termination:
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  20. Reason for Counseling Request? *
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  21. Reason for counseling description
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  22. What goals do you hope to achieve through counseling?
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  23. Preferred appointment date*

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  24.