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?

Stepping into a growth pathway takes commitment & dedication, and a willingness to face our challenges. You will be supported in this process. On a scale of 1-10 how willing are you to do 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 ready are you to let go of the old limitations and embrace growth & transformation? (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?