Faith · Recovery · Restoration · Dying to Live — Living for Christ
Application Form

Before we talk, tell us a little about you.

Anyone can call us for general information at any time. Applicants — those who want to enter Dying to Live — start here. The form takes about ten minutes. We'll review it and call you at the time you select.

Begin the Form Or Call (601) 543-4744
A hand holding a pen filling out a paper form in warm window light
General Information

Have questions? Just call.

If you're gathering information for yourself, a loved one, or a client — no form is needed. Reach us by phone during regular hours and we'll answer your questions directly.

Call (601) 543-4744
Applying to the Program

Ready to apply? Start the form.

If you are seeking to enter the Dying to Live residential program, please complete the application below. It gives us the information we need for a productive first call.

Begin the Form
Application

Application & call request

All fields marked with * are required. Your information stays with Dying to Live ministry leadership.

"I have been crucified with Christ and I no longer live, but Christ lives in me." — Galatians 2:20

1 · Who you are
Dying to Live serves men and women in separate residential houses.
2 · Treatment & recovery background
3 · Why Dying to Live
A few sentences is plenty. There is no right or wrong answer.
4 · Safety & disclosures
5 · Confirm you've reviewed the ministry information
6 · Schedule your call
Central Time (Laurel, MS)
What happens next: A member of our ministry team will review your application and call you at (or near) the time you selected. If we can't reach you, we'll try again and leave a voicemail. Urgent? Call us directly at (601) 543-4744.

Your information stays with Dying to Live ministry leadership at Christ's Church of Laurel.

"For you died, and your life is hidden with Christ in God."
Colossians 3:3 · NKJV