Exit this survey

FULL SCHOLARSHIP Application

This 2-hour workshop will help you become closer and feel more loving towards each other, as well as provide strategies to help you live together in Love & Happiness!

If you would like to apply for a FULL SCHOLARSHIP please answer the below questions as honestly as you can. (* Asterisked Questions are required to answer to be considered for a scholarship.) Please ask your partner to fill out his/her own survey.

Scholarships are not based on Financial Need, but are offered to those who I feel would most benefit from attending. (Only one scholarship per couple, per lifetime.)

Question Title

* 1. On a scale of 0 - 10, how would you rate your relationship currently?

Question Title

* 2. On a scale of 1-5, please rate your level of commitment to this relationship and working through your problems to the best of your ability.

Question Title

* 3. Please select the concerns you have from the list below. Add others that are not listed in the text box below. (Check all that apply.)

Question Title

* 4. What have you done in the past to address your concerns? (Check all that apply.)

Question Title

* 5. What is your Vision of your ideal future with your companion?

Question Title

* 6. What will your life be like if you fulfill your Vision?

Question Title

* 7. What do you foresee the future to be, if you don't fulfill this Vision?

Question Title

* 8. How serious are you at the present about resolving your concerns?

Question Title

* 9. How would you see yourself benefiting from attending this workshop?

Question Title

* 10. Thank-you for taking your time to complete this application. Please include the following identifying info so I may get back to you about whether or not you have qualified for a Full Scholarship. If you qualify, I will send you registration information and workshop details.

T