NC A & T State University Keep It R.E.A.L. Workshop Participant Registration
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Name *
Classification *
Do you live on or off campus?
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Are you representing a student organization? If so, please indicate which one below. 
What do you hope to learn or gain from this workshop? *
Age Range *
Is this your first self-love workshop?  *
Do you have time for your hobbies?  *
How often do you make time for checking in with yourself (needs, emotions, level of security, etc)?
 *
On a scale of 1-10, how often do you experience stress? *
Not at all
Very often
Do you experience symptoms of depression?
*
Do you experience anxiety?  *
On a scale of 1 to 10, how would you rate your emotional wellness?
*
Poor
Optimal
What does self-love mean to you?
 *
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