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Church INTAKE Form – Request for Services

Step 1 of 3

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Church Information
Church Name*
Church Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Church Website

Your Information
What is your name?*
First Last
What is your role?*
- Elder
- Minister
What is your email address?*
Enter Email Confirm Email
What is your phone number?*
What is the best way to contact you?*
- Email
- Phone
Are you contacting us...*
- On your own
- As a church representative

How Can We Be Helpful?
What situation prompts you to contact us? (Please describe in 4,000 characters or less.)*
How acute is the situation?*
- Immediate (24 hours)
- Very Soon (3 days)
- Soon (7-10 days)
Did you have one of our Ministry Partners in mind?*
(Copy/paste the following link in a new window for more info on each of our Ministry Partners: https://hopenetworkministries.org/our-team/partners/)
- Whoever HN thinks would be the best "fit" for our situation.
- Jimmy Adcox
- Greg Anderson
- Jon Anderson
- Lynn Anderson
- Mark Frost
- Chris Goldman
- Carlus Gupton
- Rhesa Higgins
- Evertt Huffard
- Jay Jarboe
- Grady King
- Doug Peters
- Jim Martin
- Jon Mullican
- Jason Thompson
- Phil Ware
- Julie Woodroof
- Tim Woodroof
What course of action are you anticipating? (phone call, video conference, on-site leadership meeting, etc.)*
What else do you want us to know?
Name
This field is for validation purposes and should be left unchanged.

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