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Student Care Request
Student Care is staffed by The Center for Biblical Living. For more information about CBL visit
www.centerforbiblicalliving.org
* Required
Email address
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Spouse Name (If applicable)
Your answer
Local Church you attend here is the Louisville area.
*
Your answer
Phone #
*
Your answer
Spouse Phone #
Your answer
Spouse Email
Your answer
Reason for Request
*
Your answer
Please rate the urgency of your concern:
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Not a big concern just looking for guidance
1
2
3
4
5
A major concern that effects all of life
What is your concern?
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Your answer
What have you done about this concern?
*
Your answer
Have you spoken to your church?
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Yes
No
Other:
Additional Comments:
Your answer
A copy of your responses will be emailed to the address you provided.
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