Individual Guidance Request Form

All information will remain confidential.

* First Name

* Last Name

* Gender

* Address

* Email

* Mobile Phone

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* Birth Date

* Employer

* Occupation

* Education (Level, School, Major)

* Marital Status

* Church Member Type

* I have attended and completed Grace Life Church's membership class. (GLU)

* How long have you been attending Grace Life?

* Are you a born-again Christian?

* Please check the appropriate boxes for the type of guidance needed:

* If other, please explain:

* Please give a detailed description of why you are seeking guidance:

* How long has this issue existed?

* How has this issue affected you?

* Have you spoken about this issue with anyone in GLC leadership?

* What results are you expecting from guidance?