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CCN Application Form

Thank you for your interest in Focus on the Family! Here are a few helpful tips before you begin. 

1. This application consists of 10 sections and duration to completion is dependent upon how much time you devote to responses.  An approximation is between 15 to 45 minutes. 

To preview the list of application questions, click here: CCN Application Preview
2. You must use the "Next" and "Back" buttons at the bottom of each page to navigate through the application. PLEASE DO NOT use your browser's back button to return to a previous page: this will cause you to lose your progress. 

3. A red asterisk at the end of a question indicates a required response.
4. There may be times where you might not finish this application in one session (you may not have time and need to finish it later, or your computer may crash, etc.) In order to save your progress, please copy the entire link shown below and paste it somewhere easily accessible so that you can return to this application in the future. The link will return you to where you left off. It will also be shown at the bottom of each survey page.
5. It is strongly recommended that you access this application through a computer.
6. You will be asked to upload copies of the following documents into your application:
a. A copy of your current State Mental Health License showing the Expiration Date
b. A copy of your current Proof of Malpractice Insurance showing the Expiration Date
c. A Referral Letter from a Christian Colleague within the field who knows of your spiritual walk and professional practice

PDF and Word Documents are preferred, but digital photographs of these documents are acceptable as long as they are legible.


If technical assistance is required, please contact