Marriage Support Application- | Kingdom Family Min.

Application For
Marriage Support Assistance

We are pleased to offer married couples support from a qualified professional. Please fill out the application form below and choose a service provider. Information about our service providers can be found here.

Upon receiving your application, we will contact you within 48 business hours.

Today's Date

Contact Information

First name

Last name

Street Address

City

State

Postal / Zip code

Phone

Spouse's Name

Spouse's Email Address

Demographic Information

How Many Children Live In Your Home?

Identity Verification

Indentifiction such as driver's license or state ID.

Upload File

Proof of residency such a lease agreement or utility bill.

Upload File

Select A Service Provider

Please let us know how you learned about KFM- Facebook, Interent search, or word of mouth (who or what agency).

I, the undersigned, hereby authorize the release of information to Kingdom Family Ministry board of directors for the purpose of determining program eligibility and monitoring program compliance.

Yes, I accept.

I, the undersigned, understand Kingdom Family Ministry is only providing assistance so couples can afford support for their marriages. Kingdom Family Ministry is not responsible for the selection of a service provider or the outcome of sessions with the service provider.