Prison and Homeless Shelter Scholarship Request for Stepping Up® Materials

Thank you for allowing God to use you to help change the lives and families of men who want to learn how to lead. You have a special calling, and it is our privilege to assist you with materials that are proven to make a difference in men’s lives, and will help them step up and courageously lead their homes as God intended.

FamilyLife has access to a special scholarship fund that can provide you with the materials to host a Stepping Up® men's group when you do not have the funds to purchase them.
You must apply for and be approved to receive this scholarship, after agreeing to a few basic requirements:*
- The request for scholarship funds must be made by a staff member of the organization, preferably a chaplain or warden for prisons, and from the director or full time staff member for homeless shelters.
- You do not have the funds to purchase the Stepping Up® materials without this scholarship. (Note: you may need to pay for the shipping of materials to you.)
- The chaplain or facilitator agrees to share about the experience at the end of the 10-session video series.
- Upon completion of the video series, we would like for you to give each person a signed certificate of completion.
All fields of this Scholarship Request Form must be completed. Upon agreement of each of the above conditions, click Next Page below to complete the Online Scholarship Request Form.

Your Information
Name
First Last
Email
Phone Number
Phone Type
Prison or Homeless Shelter Information
Name of Prison or Homeless Shelter*
City*
State*
Requested By:*
If you are requesting a scholarship for a prison or homeless shelter and are not a staff member for the facility, please explain your relationship to the facility and specify if you have permission from the facility's leadership to lead Stepping Up there.
If you are requesting a scholarship for a prison or homeless shelter and are not a staff member for the facility, please explain your relationship to the facility and specify if you have permission from the facility's leadership to lead Stepping Up there.
Prison or Homeless Shelter Details (Check all that apply):*
- Federal Program
- State Program
- County Program
- Rural
- Inner-City
- Private
- Work Release
- Work Camp
- Minimum Security
- Medium Security
- Maximum Security
- Juvenile
- Special Program Barracks
- Non-Denominational Ministry
- Church Ministry
Is this the ministry of a church?*
- Yes
- No
Total population of prison or estimated number of men participating weekly in the homeless shelter:*
Name of Facilitator (if different from above):
First Last
Email of Facilitator (if different from above):
Number of men planned for Stepping Up Study:*
Have you done Stepping Up in the facility before?*
- Yes
- No
When do you plan to begin this Stepping Up series?*
How did you hear about FamilyLife's Prison and Homeless Shelter Scholarship Opportunity?*
Permission*
- I understand and agree, upon finishing the Stepping Up® study, to complete a Facilitator Survey, and to provide a way for participants to voluntarily write their appreciation and testimonies. Further, if it is possible, I will also provide a group picture of participants along with the notes.
You agree to this statement
Name of person leading Stepping Up*

Re-type the name of the warden, chaplain, director, staff member or other person leading the Stepping Up program.
Stepping Up® Small-Group Series Leader Kit (only 1 per facility needed. Scholarship for kits only available in Colorado.):

Stepping Up® Small-Group Series Leader Kit (only 1 per facility needed. Scholarship for kits only available in Colorado.):
Stepping Up® video series workbook (you'll need one for each person who attends):

Stepping Up® video series workbook (you'll need one for each person who attends):
Ship To:
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Comments/Notes:
Email questions to: jcassel@familylife.com
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Prison and Homeless Shelter Scholarship Request for Stepping Up® Materials

Your Information

Prison or Homeless Shelter Information