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Support Group / Group Counseling Directory Application

National Support Group Application

Submit your groups application and get national recognition in the New Life online directory.

	Group Information:
Group Name:
Group Type:	Abortion Anger Boundaries Depression Drug and Alcohol Eating Disorders Fear and Anxiety Finding Harmony Forgiveness General Issues Grief Infidelity Marriage Self Worth and Confidence Sexual Abuse Sexual Integrity Weight Loss
Established:	(month/year)
Entry Type:	Open to public Closed to public Pre-screening Required
Gender Type:	Mixed Men Only Women Only
Leader Type:	Lay Person Church Staff Licensed Counselor Other
*Groups not lead by a licensed counselor are required to fill out these fields below.
Church Sponsor:
Church Phone:
	Meeting Information:
Fee Amount:
Day and Time:
Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
Country:
	Contact Information:
Contact Name:
Contact Phone:
Contact Email:
	Additional Notes or Comments:
Please answer these questions in the area below: 1. Has the group leader ever participated in a New Life training event? 2. Is New Life material used in this group? 3. Is your group handicap-accessible? characters remaining: Please note that there is a brief approval process before your support group will appear in the directory. Once your information is entered into the Group Directory we will contact the person noted.
Enter Security Code: