Transcending Inner Barriers Group Application Form

First name

Last name

Phone

What are you most deeply longing for?

What do you feel is currently getting in the way of actualizing it?

On a scale of 1-10 (1 is low & 10 is high), how able are you to step into your inner strengths & resources (even briefly)? (Insert your number below)

What are you hoping to get out of this group?

Every weekly session builds on the one before, so attending every session is really important. On a scale of 1-10 how committed are you to attending every session, to the best of your ability? (Insert your number below)

Stepping into a growth pathway takes dedication, a willingness to face our challenges, observe ourselves & be open to learning. You will be supported in this. On a scale of 1-10 how willing are you to step into this? (Insert your number below)

On a scale of 1-10. how willing are you to implement what you learn and take small action steps each week? (Insert your number below)*

On a scale of 1-10 how willing are you to help create a positive, uplifting & supportive group environment? (Insert your number below)

Is there anything else you would like me to know?