Intercept Request for Phase 4 Application

Desired Ceremony Month

January

April

July

October

Why do you want to transition out of an Intercept Transformation Group? *

Why do you believe you have earned the opportunity to transition into the next phase of growth? *

If approved, do you intend on attending the ceremony in person or online? *

Intercept Transcript Checklist

Memo of Understanding *

Commitment to Engage *

Basic Training Class *

Big Decision *

Bondage Breaker (2x) *

Boundaries (2x) *

Emotionally Healthy Spirituality (2x) *

The Meaning of Marriage (2x) *

Your Future Self will Thank You (2x) *

Journaling Module *

Fasting Module *

Exercise/K60 Module *

Disclosure Module *

Attend Wintercept Retreat *

Have you kept your Big Decision and maintained your planned abstinence? *

Yes

No

What month and year did you join Intercept? *

Which men have been your Transformation Group leaders since you joined Intercept? *

When was the last time you acted out? *

What is your growth and accountability plan following Transformation Group (check all that apply)? *

Lead an Intercept Group as an Alum

Join an Intercept OLT (Operational Leadership Team)

Join or Start an Intercept Growth Group

Other

Phase 4 Request - Additional Information

Part of the formal process is requesting a letter from someone significantly impacted by your transformation.

This could be your spouse, family member, friend, etc. Please provide a name and mailing address for this person below so we can contact them about this letter.

For members attending Intercept virtually:

Please provide your mailing address to receive your formal Intercept certificate upon completion of this phase of the program

Submission of Application

Part of the process to determine eligibility is a meeting with Intercept leadership. Please list your availability for a 30 minute meeting for this purpose. *