ManAlive "Virtual/Online Group" Application
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First Name *
Your answer
Last Name *
Your answer
Email *
Your answer
Address *
Your answer
Phone number
Your answer
Date of Birth *
Gender: *
Are you: *
How would you rate your marriage?
Do you have children? *
If yes, how many children?
Do you have a job (outside the home)? *
If yes, what's your vocation?
Your answer
What's your main area of struggle? *
Your answer
How long have you struggled with this? *
How often? *
Does your spouse know? *
Traumatic events in your life? (Please don't go into detail.) *
Your answer
Are you currently taking medication due to a mental disorder? *
If yes, what is the condition?
Your answer
Have you submitted your life to Jesus Christ? *
Briefly describe your relationship with your father: *
Your answer
...your mother: *
Your answer
...your siblings: *
Your answer
How did you hear about the group? *
Your answer
Why do you want to join a group? *
Your answer
What do you want to get out of the group? *
Your answer
- 6 month commitment (once a week at your designated time)
- $25/ week +$40 application fee
- Be fully present, and fully participate
- Be on time
- Be honest
- Share what shames you the most (this is the way to freedom!)
- Be respectful of your Small Group Leader, even if you disagree with them.
- Do assigned homework
- This is a group that requires you to work. If you don't want to or can't, DON'T join.
Type your name if in agreement, this will serve as your signature. *
Your answer
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