Immerse – Initial Names from Network

Immerse networks can submit the names of applicants and their mentors 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:
Applicant's Phone
Applicant's address
Please enter the Network Mentor's information below. This will help us with communicating to all members of the team.
Network Mentor's full name (first and last):
Network Mentor's email:
Network Mentor's Phone
Network Mentor's Address
Please enter the Ministry Mentor's information below. This will help us with communicating to all members of the team.
Ministry Mentor's full name (first and last):
Ministry Mentor's email address:
Ministry Mentor's Phone
Ministry Mentor's Address
Please enter the Academic Mentor's information below. This will help us with communicating to all members of the team.
Academic Mentor's full name (first and last):
Academic Mentor's email address:
Academic Mentor's 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: