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* 1. What is your preferred name?

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* 2. What is your gender(s)?

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* 3. At what email address would you like to be contacted with your decision?

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* 4. What is your sexual orientation?

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* 5. What is your age?

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* 6. Are you currently enrolled as a student?

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* 7. Will you be able to subsidize this training with professional development reimbursement or independent study credits?

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* 8. Do you have prior experience attending a stress management training?

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* 9. Do you have prior experience attending a training regarding your purpose?

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* 10. Do you identify with any of the following spiritualities or faith traditions? (Please select all that apply.)

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* 11. What is your ethnicity? (Please select all that apply.)

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* 12. Do you have experience with healing arts or expressive arts?

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* 13. The total cost of this 5-session Mastermind Program Series is $575. Contact me, I:

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* 14. I would like to refer my friend/colleague. Their name & contact information is:

Congratulations! Your application is complete. We will be in touch shortly to get to know you better; and confirm your next steps to enroll.

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