Advocacy Form

Thank you for your willingness to consider serving as an advocate! We understand it is both a sacrifice and privilege to come alongside someone who needs care during this season of life. This form will help us better understand how we can best prepare for our time together.

"*" indicates required fields

Today's Date*

Name*

First Last

Age*

Occupation

Best phone number to reach you:*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you have any food allergies/restrictions? If yes, please explain. If no, please put n/a.*

Counselee's Name*

First Last

What is your relationship to the counselee and how long have you known him / her?*

From your perspective, what is the core problem, and what do you think has contributed towards this person's need for counseling?*

What would you like to see happen in the life of this individual / family? And how do you see yourself assisting?*

What has been your involvement with the counselee regarding the situation bringing them to TS up to this point?*

What else might be helpful for us to know about the counselee?*

While not necessary, have you had any counseling training? If so, what kind and from where?*

Thank you again for taking the time to fill out this form!

We will be reviewing all the forms related to this case before letting the counselee(s) know some tentative dates for your time with us. Please connect with the counselee(s) to coordinate your schedules.

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Advocacy Form

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A partnering ministry of the

812-597-1212 | TSOFFICE@TWELVESTONES.ORG
4826 W BEAR CREEK CHURCH ROAD | MORGANTOWN, IN 46160