JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Enrolment Form
Please complete the form, and return it via email. We will then schedule a time to speak with
the facilitators via Zoom (a Skype alternative).
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Full Name
*
Your answer
Location
*
Your answer
1. What interests you in taking this program
*
Your answer
2. Tell us about your intended book! :)
*
Your answer
3. What is your background (in relation to this training)?
*
Your answer
4. What do you think you may find challenging about the training?
*
Your answer
5. Please tell us about any physical or mental issues you have. This is important for us to know about in order to support you in the learning process.
*
Your answer
6. If you are living with disability could you please provide a little more detail about the disability and how we can support your learning:
*
Your answer
7. Are there any medications or substances you take regularly?
*
Your answer
8. If you are in any process of recovery, for example from surgery, cancer, substance use, relationship break up, grief, psychosis or spiritual emergency, please tell us about it here:
*
Your answer
9. Any other information you wish to provide?
Your answer
Thanks for this! We will get in touch with you very soon! Or you can email us Dr. Martha Tara Lee at
drmarthalee@eroscoaching.com
.
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
