Exchanged Life Center

Practicum Information:

Address

Street Address *

City *

State *

Country

Postal Code *

First Name *

Last Name *

Mobile Phone *

Email *

Personal Story Highlights *

We'd love to get to know you! Please share a few highlights of your personal story.

Biological Gender *

Male

Female

Date of Birth *

Marital Status *

Emergency Contact Information *

Please provide the name, relationship, email, and phone number of your emergency contact.

Estimated Graduation Date *

If you're not sure, just give us your best guess!

The Exchanged Life

Describe The Exchanged Life? *

Describe in your own words The Exchanged Life and share what impact it has had in your life?

Explain Identity in Christ *

In your own words, explain the believer's identity in Christ.

What is Biblical Forgiveness? *

What is your understanding of Biblical forgiveness?

Explain Brokenness and Surrender *

How would you explain the concepts of brokenness and surrender to a counseling client?

Practicum Goal and Benefits FOR YOU *

What is your goal for participating in the practicum? How do you expect using your practicum training in the future?

Availability & Consent

Practicum Payment Agreement *

$950 - Single payment due prior to practicum start

$350 / month (for 3 months) - Total price $1,050

If accepted, I agree to pay the Practicum fee with one of the above options. You may change your option if needed prior to the practicum start.

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out at any time.

By checking this box, I consent to receive marketing and additional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out at any time.

Signature *

Clear

Captcha

Privacy Policy

Call 770.404.9896

Email: [email protected]

Privacy Policy

Terms of Use

Exchanged Life Center

© Copyright 2025. Exchanged Life Center. All rights reserved.