Please select the option that applies to you:
Addictions Victorious ProgramResidential ProgramNon-Residential Program/Care Group

MINISTRY REPRESENTATIVE'S PERSONAL INFORMATION

Your Name*

Email*

Cell Phone Number*

MINISTRY INFORMATION

What is the name of the ministry, church, or program that you serve with?*

What is your role or title in the ministry you serve with?*

Is the ministry residential or non-residential?*
ResidentialNon-ResidentialOther

Why are you interested in partnering with TAC and being listed among other Biblical addiction ministries?*

What country is the ministry located in?*
U.S.A.Other

If Other, Please type country

Ministry's Street Address with City, State, & Zip*

Ministry Phone Number (if any)

MINISTRY REPRESENTATIVE'S SPIRITUAL BACKGROUND

Briefly explain your conversion to Christ*

Local Church Affiliation*

Local Church Address*

Church Denomination*

PRIOR TRAINING

Are you a certified Biblical Counselor?*
YesNo

If yes, with what organization(s) are you certified?

Have you read any of the following books? Check off completed ones.
Heart of Addiction - Mark ShawAddictions: A Banquet in the Grave - Edward WelchGospel Treason - Brad BigneyThe Useful Lie - Wm. Playfair & Geo. Bryson

Do you have any Biblical Counseling training?*
YesNo

Give titles and dates of Biblical Counselor training attended (Max of 5)

Do you have any addiction counseling experience?*
YesNo

Give BRIEF Description of Addiction Counseling Experience

Would you be willing to become a Commissioned Addictions Biblical Counselor (CABC) with The Addiction Connection within the next year?

INTERVIEW QUESTIONS (Keep answers brief!)

Describe why you are passionate about addiction counseling.

Describe in detail the books, resources, and persons who have had the most influence on your thinking and approach to addiction.

Name 3 essential concepts to your approach to addiction counseling.

Describe the problem of addiction.

How do people become addicts? What are some underlying issues and causes?

Describe the solution of addiction. Include key concepts in the process of addiction and give an example of how you counsel or teach someone to understand those key concepts.

Describe how you would address related addiction issues such as: anger, dishonesty, people-pleasing, loneliness, and resentment. Feel free to include other issues.

What curriculum or Bible study material(s) do you currently utilize in your program, ministry, or church?

What are your goals for a counselee in addiction counseling? Describe why these goals are important and how you measure them. How do you define “success”?

Is there a place in addiction counseling for the Word of God and the Holy Spirit? Explain your answer.

What, if any, is the role of the local church in the life of someone struggling with an addiction?