Renewed Mind
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Renewed Mind
Meet Mark
Work with Me
Journal
Free Consult
Pastor Portal
Classes
Consent Form
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Renewed Mind
Meet Mark
Work with Me
Journal
Free Consult
Pastor Portal
Classes
Consent Form
Renewed Mind:
Application for Financial Assistance
Renewed Mind receives donations so that those who NEED assistance can get the proper counseling. Upon APPROVAL, Renewed Mind will seek out sponsorship on your behalf. (Your Information is kept confidential)
*
Indicates required field
Name
*
First
Last
If this request is on behalf of someone else, what is there name and age?
*
Phone Number
*
Email
*
Choose what applies to your situation:
*
Single
Married
Separated
Divorced
Widowed
Child(ren)
Jobless
Addict
Depressed
Share in your own words why you NEED financial assistance
*
How much are you ABLE to contribute at this time? (per session)
*
$20
$40
$60
$80
Thank you for taking the time to fill out this form. We will prayerfully consider your application and get back to you ASAP. May the Lord bless you and keep you! Talk to you soon.
Submit
