Group Program Application Form
Please take 5 - 10 minutes to complete this form.
What are your pronouns?
How do you identify?
Describe the type of life you desire to live? Be specific.
What is the single biggest struggle you have in reconciling your faith and your sexuality? Be specific.
How long have you been working on reconciling your faith and sexuality?
6 months to 2 years
3 years or more
On a scale of 1-10 how urgent is making peace with your faith and sexuality? 1 means "it will work itself out" and 10 being "if this doesn't work I'll lose myself forever"
It will work itself out
If this doesn't work I'll lose myself forever
How quickly would you like to see results in reconciling your faith and your sexuality?
2 - 4 weeks
6 - 8 weeks
9 - 12 weeks
In your own words, what are you desiring to achieve by joining the group program?
Have you tried other programs or counseling to help you with making peace with your faith and sexuality? If so, list them here.
Is there a friend/family you would like to join you AND who you believe would benefit from this program?
The total financial investment for the program is $1,500. Which method of payment would work best for you? (Payment is NOT required right now.)
Pay in full
Payment Plan (max 3 payments)
Thank you for completing this application. You will receive a response within the next 72 hours. If you are a good fit for the program the next step will include a 30 minute welcome video call with Coach Yeamah.
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