Mentorship Application
This 1:1 Mentorship program is designed for those who are seeking deeper self connection and new ways of being embodied. Sessions are a blend of somatic awareness and creative care practices to help you get-in-touch, revitalize, and awaken authenticity. To ensure we are a good match to come together in a co-creative process of learning and healing, please submit an application to be considered for the Mentorship program. It is important to me that our values align so that your growth and healing can be fully supported.
Sign in to Google to save your progress. Learn more
Email *
What is your name and pronouns? *
Where are you located? *
What is your motivation in seeking somatic support/guidance? What brings you to this work? *
200 words or less
Do you have any diagnoses and/or medical conditions I should know about? *
Name three challenges that are present in your life right now. *
200 words or less
Name three aspects of your life that bring you a sense of joy and pleasure. *
200 words or less
How would a good friend describe you? (Highlight some of your characteristics, quirks, eccentricities, passions, and skills.) *
200 words or less
What would you hope to gain from working together? *
200 words or less
Name a few of your core values. *
200 words or less
Are you interested in a 3, 4, 5, or 6 sessions? *
Check off what elements would be most exciting and beneficial for you to engage in. *
This Mentorship program requires your full commitment for the agreed upon timeframe. Are you ready for this investment of your presence?
Clear selection
Please share anything else you'd like for me to know! *
Thank you for filling out this application. I sincerely look forward to reading your response and connecting with you soon.
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy