Application Form — Scott Fussnecker

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The Word With Fuss

The Word With Fuss

The Word With Fuss

Church Momentum Course – Application Form

For Pastors and Church Leaders

Thank you for your interest in the 10-Month Church Momentum Course, created to equip pastors and church leaders with practical tools and support for advancing mission and ministry. Please complete the form below.

Section 1: Personal Information

First Name

Last Name

Phone Number *

(###)

###

####

Email *

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Section 2: Church & Ministry Information

Church Name

Church Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Role/Title in the Church

Senior Pastor

Associate Pastor

Ministry Leader

Other

How long have you served in your current role?

Less than 1 year

1-3 years

3-5 years

More than 5 years

Denomination or Church Affiliation (if applicable)

Section 3 Coaching Expectations & Commitment

Why are you interested in Church Momentum Coaching?

What are the top 2–3 challenges your church is currently facing?

What outcomes would you like to see from participating in coaching?

Are you able to commit for a 10-month duration?

Yes

No

Unsure

Section 4: Consent & Confirmation

Full Name *

Type your full name as a digital signature

First Name

Last Name

Date

MM

DD

YYYY

Thank you!

© 2025 by Scott Fussnecker