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Partner Application Form

We are excited you are interested in being a partner in our Scholarship Expansion Program and Provider Network. Once vetted, you will be listed on our approved referral list and be eligible to receive scholarship funds toward a 10|10 referred client. Please complete this application form as the next step. We will follow up with a phone call once reviewed to discuss "partner rates" and the scholarship process.

Who are you applying for? Check all that apply.
Are you open to offer a discounted rate for a ministry leader regardless of receiving scholarship funds?
Please confirm (if applicable): "I am in good ethical standing with my professional governing board."
Do you agree with 10|10's statement of faith? See below.

10|10 Ministries Statement of Faith & Principle and Approach. (Pease note, we provided our principle and approach to give insight into 10|10. We are not asking you to agree with this portion.)

Statement of Faith

Please upload your logo or picture that you prefer to be displayed on the 10|10 website "partner page"  Please note: If you choose not to, your "space" will appear void.

Upload File

Thank you! We have received your application.

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