Network Application Winning At Home Network Application Name Title Organization Email Address Phone Professional Degree License Type and Number Liability Insurance Location Specifics Location Specifics Church Corporation Independent Office Other If other - Please Specify Staff Staff Director Therapists Coaches Administrative Support Members None Please List Number Of Each Staff Briefly describe the location where you are currently practicing/doing ministry Why do you want to be part of the Winning at Home Network? What do you hope the Winning at Home Network can do for you? What opportunities are you hoping to have with the Winning At Home Network? What sort of support do you anticipate needing? What do you anticipate your biggest needs from the Winning at Home Network? How will joining the Winning at Home Network contribute to your current practice or ministry? When are you hoping to partner with the Winning at Home Network? How does your faith inform your desire to be part of Winning at Home? How does your faith inform your practice and/or ministry? Are you willing to participate in devotions and other meetings, either in-person meetings or on ZOOM? Are you willing to participate in devotions and other meetings, either in-person meetings or on ZOOM? Yes No Are you able and willing to participate in person for initial training, if it is deemed necessary? Are you able and willing to participate in person for initial training, if it is deemed necessary? Yes No Are you willing and able to pay the Winning at Home Network Fees? Are you willing and able to pay the Winning at Home Network Fees? Yes No I would like to request more information about the fees. In reviewing Winning at Home’s faith and value statements, how do your beliefs align with them? 2 + 11 = Submit
