Counseling and Coaching Services at Southgate Church

Thank you for considering our volunteer lay counselors and coaches at Southgate Church Crestwood. Please fill out this form and click submit. This brief form helps us best serve you. Upon submitting this form, you will receive a confirmation email with your submission. Our administrator will be in contact with you to further discuss scheduling and services. Thank you!

Name

This address will receive a confirmation email

Phone

Preferred form of contact for scheduling (Select all that apply)

Please select one option.

Text Call Email

Address

Gender

Please select one option.

Male Female Rather Not Say

Age Range

Please select one option.

Minor (Under 18 years old) 18-21 Years Old 22-29 Years Old 30-39 Years Old 40-49 Years Old 50-59 Years Old 60-69 Years Old Over 70 Years Old

Do you attend Southgate Church?

Please select one option.

Yes, I attend Southgate Church I attend a different church I do not attend church

Are you seeking coaching or lay counseling?

Please select one option.

Coaching Lay Counseling

Have you received counseling or coaching before?

Please select one option.

Yes, by a professional counseling and/or coaching service Yes, by a volunteer counseling and/or coaching service I have never received counseling and/or coaching

In a few sentences, please briefly describe why you would like to receive counseling or coaching

Please provide your availability for counseling and coaching meetings (check all that apply)

Please select all that apply.

Mondays 9am-12pm Mondays 12pm-5pm Mondays 5pm-9pm Tuesdays 9am-12pm Tuesdays 12pm-5pm Tuesdays 5pm-9pm Wednesdays 9am-12pm Wednesdays 12pm-5pm Wednesdays 5pm-9pm Thursdays 9am-12pm Thursdays 12pm-5pm Thursdays 5pm-9pm Fridays 9am-12pm Fridays 12pm-5pm Fridays 5pm-9pm Saturdays 9am-12pm Saturdays 12pm-5pm Saturdays 5pm-9pm

Counseling and Coaching Services at Southgate Church

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