Sponsorship Request Form | CV Biblical Counseling Center

Sponsoring Church / Business / Agency *

Authorized Contact Name *

Authorized Contact Phone *

Authorized Contact Email *

How would you like to receive monthly invoices? *

Email
Mail

Invoice Email Address *

Invoice Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Referral / Client Name(s) *

Individual, child, couple, or family

Sponsorship Type *

Monthly Pledge (usage-based)
Per-Session Sponsorship
Combination Sponsorship
Hardship Coverage

Type Name Number

Total Monthly Pledge Amount

Suggested Client Contribution Per Session (optional)

Amount Per Session

$80 (full session)
$40 (half session)
Other

Custom Amount Per Session

Number of Sessions

Unlimited Sessions

Yes, enable unlimited sessions

Describe Combination of Full and Half Sessions

Hardship Coverage Agreement

Will cover any portion of the $80 session fee the client cannot pay

Additional Notes

Contact Preference

Request counselor call when sponsored funds or sessions are exhausted

Follow-Up Contact Name

Follow-Up Contact Phone

Process Donation

Now via Credit / Debit Card
Send me an invoice to pay with check
Send me an invoice to pay with ACH

Total Donation *

Thank you for donating, there are so many options above, with differing mix of costs, so we ask that you put the amount you are donating here, and we will allocate it properly.

Minimum Price: $10.00

Stripe Credit Card *

Card

Name on Card