AHAM Education (Academy of the Heart and Mind) Mind Body and Mindfulness Interest Form
Thank you for your interest. Kindly fill out the form below. Your responses are held in highest confidentiality, are not distributed to other parties, and allow us to determine how to best serve the needs of those interested in our programs. Please contact knellee@ahameducation.org or (954) 873-4508 for questions or comments, or go to http://www.ahameducation.org to learn more about us.
First Name *
Last Name *
Please indicate the personal pronoun you would like to be called (she, he, they, zie, etc)
Best contact number *
Age *
Zip code where you reside *
Zip code where you work / attend school *
Email address *
How have you or your family been adversely affected by COVID? *
Required
Please describe your racial/ethnic identity (check all that apply) *
Required
Please describe your gender identity (check all that apply): *
Required
Profession / Occupation *
Prior Experience with Mindfulness and Mind Body Tools (none necessary) *
Why do you want to take this program? What do you hope to gain? *
If you are applying for a scholarship, please explain why? If not, just write in N/A. *
How did you find out about this program *
Required
Thank you for your interest, we will be contacting you soon.
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