Immerse – Initial Names from Network

Immerse networks can submit initial names of applicants to the Immerse program via this form.

All information must be complete for the form to send.

Immerse Network Name:
Applicant's full name (first and last):
Applicant's email address:
Network Mentor's full name (first and last):
Network Mentor's email:
Ministry Mentor's full name (first and last):
Ministry Mentor's email address:
Academic Mentor's full name (first and last):
Academic Mentor's email address:
Please enter the context or location of the applicant's ministry, i.e. church name, or church plant name or project name etc.
Ministry Location Name
City or Town or Area
Your name (first and last):
Additional Information: