Network Application Form

Date *

MM

DD

YYYY

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Phone *

(###)

###

####

Secondary Phone

(###)

###

####

Church/Ministry Phone

(###)

###

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Church/Ministry Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Ministry Interest

I am willing to serve HCI in the following ways (please select all that apply).

Teacher/Facilitator

Administrative Support

Fundraising Support

Board Member

Other (please describe below)

Experience Participating

Please check all of the following that you have attended as a participant.

Abiding

Belonging

Facing Life's Losses

Forming

HeartSync Prayer Ministry

Immanuel Journaling

Immanuel Prayer Ministry

Joy Starts Here

Listening for Heaven's Sake

Living Relationally

Restarting

Theophostic Prayer Ministry (recipient)

Thriving DC (HCI annual conference or leader advance)

Other (please describe below)

Experience Facilitating

Please check all of the following that you have taught or facilitated (including as a co-teacher).

Abiding

Belonging

Facing Life's Losses

Forming

HeartSync Prayer Ministry

Immanuel Journaling

Immanuel Prayer Ministry

Joy Starts Here

Listening for Heaven's Sake

Living Relationally

Restarting

Theophostic Prayer Ministry (commissioned or trained, please describe below)

Other (please describe below)

Have you read and do you agree with HCI's mission, vision, values and beliefs?

Mission, vision, values and beliefs can be found at: GodHealsToday.org/about-hci

Yes

No (please explain below)

We ask that our members support HCI financially (at any level). Are you able to make a financial gift?

We ask that you prayerfully consider how much God would have you give.

Yes

No

Network Application Checklist

Please check which of the following you have completed as of today.

I have paid my $30.00 application fee

I have submitted my references

I will complete a background check

I will complete my child protection training

I have completed my application (this form)