"Waking Up to Your Life" Application Form
Thank you for your interest in the beta version of this program! Because we want to make sure that this program is a good match for what you are seeking, your answers to these questions will be most helpful. Please submit your application no later than Monday, January 5, 2014. Once we receive your application we will respond to you within 3-4 days to let you know how to enroll.
* Required
Your name
*
Your answer
Email address
*
Your answer
Phone number
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Your answer
Mailing address
Your answer
How did you hear about "Waking Up to Your Life"?
Maia's e-newsletter
Facebook
Liberated Life Project website
Other:
Clear selection
Do you currently have a meditation or other contemplative practice?
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Yes
No
Other:
If you answered 'yes,' please tell us what your practice is (e.g. meditation, yoga, etc.), and how long have you had this practice.
Your answer
Please tell us a little bit about how you hope to benefit from participating in "Waking Up to Your Life."
*
Your answer
The fee for this beta (first-run) version of the three-month program will be $150. We are committed to making “Waking Up to Your Life” accessible to people with various income levels, and so we have set aside several partial-scholarship spaces. If you are unable to afford the regular program fee, please describe your situation in the space below and let us know what you would be able to pay.
Your answer
We plan to set up a private Facebook group as a way for participants to check in with us and each other on a regular basis. In order for you to get the most out of this program, it will be important for you to be able to use the Facebook page in this way. Is this something you are willing to do?
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Yes
No
Other:
A contemplative practice is an essential ingredient in a healthy life. It is also important to recognize that increasing the intensity of such a practice may bring up issues that you may need to deal with in other ways. By checking the ‘YES! box below, you indicate that you understand this program is not a substitute for professional counseling or psychotherapy, and that you will seek additional support if necessary.
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YES!
Required
Please let us know any other questions you may have about this program... or any other comments!
Your answer
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