Intake Form to see a Life Support Mentor
The Support for Life Ministry has a trained team of Life Support Mentors who come alongside people in difficult seasons or situations to minister insight, healing, and spiritual growth in a one-on-one, non-clinical environment.
Life Support Mentors meet with individuals on a short term basis and are trained to provide a listening ear, supportive encouragement, empowered prayer, and biblical guidance.
If you’re a member or regular attender and would like to meet with a life support mentor, please fill out this form and our pastoral staff will be in contact.
The following is what you can expect from your Life Support Mentors and the Support for Life Ministry:
Empathy and understanding no matter what circumstances you find yourself.
Collaboration in setting goals and steps of faith.
Assistance in connecting with Jesus.
The following is not provided by your Life Support Mentor from the Support for Life ministry:
Professionally trained or licensed counselor, social worker, or psychologist.
A diagnosis of a mental or emotional disorder.
If the pastoral staff deems Life Support Mentoring appropriate for you at this time, please commit to this process through the following ways:
Keep your scheduled appointments (canceling two or more times will result in termination of Life Support Mentorship).
Do your assigned homework and readings.
Seek God and embrace this opportunity that he is providing you.
Life Support Mentors will keep confidential all comments made in the context of their sessions with the following exceptions:
If counselees disclose the intention to take harmful, dangerous, or criminal action against another human being or against him or herself, the life support mentor is required to inform all appropriate parties (emergency services, enforcement officials, child protective services, the church, family of counselee, etc.)
Suspected acts of child abuse or neglect on the behalf of the counselee will be reported to the proper authorities.
All Life Support Mentors reserve the right to discuss matters disclosed by counselees for the purpose of receiving supervision, counsel and oversight. Those matters will be discussed with the Support for Life pastoral staff or a pastoral care leader.
Individuals need to go to the nearest hospital emergency intake (or other emergency service) if they feel suicidal or homicidal and may act on these impulses. They may also contact the following agencies:
Grant/Riverside Behavioral Health 614.566.5056
Netcare Access 614.276.2273
Suicide Prevention 614.221.5445
Suicide Prevention for Teens 614.294.3300
Suicide Prevention for Seniors 614.294.3309
Please note: because of the high volume of requests, we will only be able to place you with a life support mentor once within a two-year period. We encourage you to follow the program to completion.
If you have any questions, please call 614.259.5489.
We welcome you as you pursue healing in Christ through this ministry.
Please type your full name and the date below, stating you have read this entire application and agree to the level of commitment requested to participate.
Signature (please type full name):*
Please provide the following information:
Have you either of you or your spouse been previously married?:*
If yes to above, please explain:*
Children (names, ages:*
How did you hear about Life Support Mentoring?*
Do you attend Vineyard Columbus?*
If yes to above, what campus and service?*
Would you prefer a Spanish-speaking counselor?*
Would you describe yourself a Christian?*
Please describe your testimony of coming to Christ*
Briefly describe your health*
List any significant illness or injury*
Have you ever seen a psychiatrist, psychologist or mental health professional?*
If yes, please explain reasons*
Are you currently seeing a psychiatrist, psychologist or mental health professional?
If yes, please explain reasons*
What is the main issue that has brought you here for Mentoring?*
What have you done about this issue?*
What are your expectations for the Support for Life Ministry and your time with your Mentor?*
Please share any additional information we should know
Level of Concern with Following Issues (Rate 0-5, 0=No Concern, 5=Serious Concern)
Poor Self Discipline*
Poor Social Relationships*
Any Other Area Not Listed
Please indicate level of concern*