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Prison and Homeless Shelter Scholarship Request for Stepping Up® Materials
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Thank you for allowing God to use you to help change the lives and families of men who want to learn how to lead. You have a special calling, and it is our privilege to assist you with materials that are proven to make a difference in men’s lives, and will help them step up and courageously lead their homes as God intended. FamilyLife has access to a special scholarship fund that can provide you with the materials to host a Stepping Up® men's group when you do not have the funds to purchase them. You must apply for and be approved to receive this scholarship, after agreeing to a few basic requirements:
*
The request for scholarship funds must be made by a staff member of the organization, preferably a chaplain or warden for prisons, and from the director or full time staff member for homeless shelters.
*
You do not have the funds to purchase the Stepping Up® materials without this scholarship. (Note: you may need to pay for the shipping of materials to you.)
*
The chaplain or facilitator agrees to complete a brief survey at the end of the 10-session video series or 4-session video event to describe the experience.
*
Upon completion of the video series or video event, we would like for you to give each person a signed certificate of completion.
All fields of this Scholarship Request Form must be completed. Upon agreement of each of the above conditions, click Next Page below to complete the Online Scholarship Request Form.
Your Information
Name of Prison or Homeless Shelter
*
City
*
State
*
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
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Requested By:
*
Prison Warden
Prison Chaplain
Director of Homeless Shelter
Staff Member of Prison or Homeless Shelter
Other
If you are requesting a scholarship for a prison or homeless shelter and are not a staff member for the facility, please explain your relationship to the facility and specify if you have permission from the facility's leadership to lead Stepping Up there.
Name
First
Last
Email
Phone Number
Phone Type
Mobile
Office
Home
Prison or Homeless Shelter Information
Prison or Homeless Shelter Details (Check all that apply):
*
Federal Program
State Program
County Program
Rual
Inner-City
Private
Work Release
Work Camp
Minimum Security
Medium Security
Maximum Security
Juvenile
Special Program Barracks
Non-Denominational Ministry
Church Ministry
Is this the ministry of a church?
*
Yes
No
Total population of prison or estimated number of men participating weekly in the homeless shelter:
*
Name of Facilitator (if different from above):
First
Last
Email of Facilitator (if different from above):
Number of men planned for Stepping Up Study:
*
Have you done Stepping Up in the facility before?
*
Yes
No
When do you plan to begin this Stepping Up series or event?
*
How did you hear about FamilyLife's Prison and Homeless Shelter Scholarship Opportunity?
*
Permission
*
I understand and agree, upon finishing the Stepping Up® study, to complete a Facilitator Survey, and to provide a way for participants to voluntarily write their appreciation and testimonies. Further, if it is possible, I will also provide a group picture of participants along with the notes.
You agree to this statement
Type name of person leading Stepping Up here
*
Re-type the name of the warden, chaplain, director, staff member or other person leading the Stepping Up program.
Stepping Up® Small-Group Series Leader Kit (only 1 per facility needed):
Stepping Up® Small-Group Series Leader Kit (only 1 per facility needed):
Stepping Up® Video Event Leader Kit (only 1 per facility needed):
Stepping Up® Video Event Leader Kit (only 1 per facility needed):
Stepping Up® Video Event Manual (you'll need one for each person who attends; the event manual is wire-bound):
Stepping Up® Video Event Manual (you'll need one for each person who attends; the event manual is wire-bound):
Ship To:
First
Last
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Comments/Notes:
Email questions to: HREF="mailto:dadair@familylife.com">dadair@familylife.com
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