Your Journey Starts Here: Participant Application Survey

IMPORTANT

This is a safe and confidential space.
Your honesty helps us determine if this experience is the right fit for you.

The Journey Training™ is intense, immersive, and requires full personal responsibility.

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* 1. Name:

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* 2. Email:

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* 3. Phone:

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* 4. Referred by (name):

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* 5. Referred by (phone):

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* 6. Why do you feel now is the time for you to attend The Journey Training?

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* 7. What patterns, limitations, or areas of pain are you committed to breaking through?

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* 8. When something isn’t working in your life, how do you typically respond? (Please be honest)

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* 9. To what extent do you believe you are responsible for the results in your life?

Not responsible

Somewhat responsible

Fully responsible

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* 10. Are you willing to take full ownership of your thoughts, behaviors, and results—without blaming others, circumstances, or your past?

Yes

Not Fully- Explain

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* 11. How do you typically respond when someone gives you direct or challenging feedback?

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* 12. Have you attended personal development trainings, therapy, or healing work before?
If yes, please describe what you participated in, when, and how it impacted you?

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* 13. Are you prepared to be coached, challenged, and held accountable—even when it’s uncomfortable?

Yes, bring it on

I have some hesitation. Explain why

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* 14. On a scale of 1–5, how would you rate yourself in the following areas?

	Not at all	A little	Sometimes	Often	Fully
Willing to give it your all	Willing to give it your all Not at all	Willing to give it your all A little	Willing to give it your all Sometimes	Willing to give it your all Often	Willing to give it your all Fully
Open to try new things	Open to try new things Not at all	Open to try new things A little	Open to try new things Sometimes	Open to try new things Often	Open to try new things Fully
Trusting others in a process	Trusting others in a process Not at all	Trusting others in a process A little	Trusting others in a process Sometimes	Trusting others in a process Often	Trusting others in a process Fully
Determined to change	Determined to change Not at all	Determined to change A little	Determined to change Sometimes	Determined to change Often	Determined to change Fully

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* 15. Are you currently seeing a therapist, psychiatrist, or other mental health professional? What type of support? How often?

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* 16. Have you ever been diagnosed with any of the following?

Anxiety

Depression

PTSD

Bipolar Disorder

Schizophrenia

Psychosis

Psychiatric hospitalization

Other (please specify)

None of the above

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* 17. Are you currently taking any prescription medications? List medication, dosage and why you are taking it?

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* 18. Do you currently have, or have you previously experienced, challenges with any form of addiction or dependency?

	none	Minimal	Moderate	Significant	Strong dependency
Caffeine	Caffeine none	Caffeine Minimal	Caffeine Moderate	Caffeine Significant	Caffeine Strong dependency
Alcohol	Alcohol none	Alcohol Minimal	Alcohol Moderate	Alcohol Significant	Alcohol Strong dependency
Tobacco	Tobacco none	Tobacco Minimal	Tobacco Moderate	Tobacco Significant	Tobacco Strong dependency
Marijuana	Marijuana none	Marijuana Minimal	Marijuana Moderate	Marijuana Significant	Marijuana Strong dependency

Other (please specify)

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* 19. Do you have any physical conditions we should be aware of?
(Chronic pain, mobility, injuries, etc.) How long have you had the condition?

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* 20. Do you have a history of seizures?

Yes. Are you taking medication? What kind of seizures? How long have you been diagnosed?

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* 21. Do you have any food allergies or dietary restrictions?

Yes

Other (please specify)

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* 22. Are you vegan?

Yes

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* 23. Are you able to drive yourself and possibly others to/from the training?

Yes. Vehicle type?

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* 24. This training requires honesty, ownership, and a willingness to face yourself fully.
Why do you believe you are ready for this level of work?

The Awakening Trainings™ reserves the right to approve or decline participation based on readiness, safety, and alignment.
Our priority is to create a powerful, responsible, and high-integrity environment for every participant.

Your Journey Starts Here: Participant Application

Question Title

* 1. Name:

Question Title

* 2. Email:

Question Title

* 3. Phone:

Question Title

* 4. Referred by (name):

Question Title

* 5. Referred by (phone):

Question Title

* 6. Why do you feel now is the time for you to attend The Journey Training?

Question Title

* 7. What patterns, limitations, or areas of pain are you committed to breaking through?

Question Title

* 8. When something isn’t working in your life, how do you typically respond? (Please be honest)

Question Title

* 9. To what extent do you believe you are responsible for the results in your life?

Question Title

* 10. Are you willing to take full ownership of your thoughts, behaviors, and results—without blaming others, circumstances, or your past?

Question Title

* 11. How do you typically respond when someone gives you direct or challenging feedback?

Question Title

* 12. Have you attended personal development trainings, therapy, or healing work before?If yes, please describe what you participated in, when, and how it impacted you?

Question Title

* 13. Are you prepared to be coached, challenged, and held accountable—even when it’s uncomfortable?

Question Title

* 14. On a scale of 1–5, how would you rate yourself in the following areas?

Question Title

* 15. Are you currently seeing a therapist, psychiatrist, or other mental health professional? What type of support? How often?

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* 16. Have you ever been diagnosed with any of the following?

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* 17. Are you currently taking any prescription medications? List medication, dosage and why you are taking it?

Question Title

* 18. Do you currently have, or have you previously experienced, challenges with any form of addiction or dependency?

Question Title

* 19. Do you have any physical conditions we should be aware of?(Chronic pain, mobility, injuries, etc.) How long have you had the condition?

Question Title

* 20. Do you have a history of seizures?

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* 21. Do you have any food allergies or dietary restrictions?

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* 22. Are you vegan?

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* 23. Are you able to drive yourself and possibly others to/from the training?

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* 24. This training requires honesty, ownership, and a willingness to face yourself fully.Why do you believe you are ready for this level of work?

* 12. Have you attended personal development trainings, therapy, or healing work before?
If yes, please describe what you participated in, when, and how it impacted you?

* 19. Do you have any physical conditions we should be aware of?
(Chronic pain, mobility, injuries, etc.) How long have you had the condition?

* 24. This training requires honesty, ownership, and a willingness to face yourself fully.
Why do you believe you are ready for this level of work?