Referral Counselor Application

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Dear Counselor,

Thank you for your submission to join the Hope for Wholeness Network! We’re excited about the prospects of us working together; and a ministry outreach being available to hurting people in your area.

See Definition of “Referral Counselor” in the HFW Standards Manual. Please read carefully. If you do not have a confidential group ministry within your practice, not all of this application applies to you. Skip what areas do not apply.

This application will also serve as your annual renewal form. Your annual renewal will be 12 months from your application date.  You’ll be given 30 days in advance reminder notice.

We prefer that you complete our online applications for Network memberships online. If you have any questions, please do not hesitate to give us a call at 864-583-7606, M-F, 9AM-5PM EST.

We have secured your application and the information you share, including credit card information, using  128 bit encryption SSL certification. However, if you feel uncomfortable about submitting this information online, you may type all the information in the form, and then print. Any information typed outside the visible box will not be seen, and must be put on an additional page, attached to your application. To print, type and hold Ctrl then “P,” and print the form.  You may scan/email to support@hopeforwholeness.org,  or mail to PO Box 5781, Spartanburg, SC, 29304.

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