Individual Services Interest Form
We cultivate Circles of Care through healing justice frameworks that embolden practitioners to integrate radical love and belonging in their homes, classrooms, communities, and beyond. De Corazon envisions a safe and equitable world where restorative interactions transform individuals, relationships, communities and systems through the prevention, repair and deep healing of harm.
Sign in to Google to save your progress. Learn more
Full Name
Preferred Method of Contact (Phone/Email/Social Media)
We bring an intersectional analysis of systemic oppression and movement building to teach the critical skills needed to change behavior, interactions, conflicts, internal dynamics, and organizational culture. What services are you interested in? (Include all that apply)
Please explain why you are interested in the service(s) you selected?
What is your desired timeline?
Clear selection
What do you look forward to learning?
What type of training have you already received?
I feel fulfilled at this stage of my life
not really
big time
Clear selection
I talk kind and am encouraging of myself
not really
big time
Clear selection
I know how to manage my stress
not much
yes big time
Clear selection
I have given my all to grow and fulfill my purpose on Mother Earth the past month
not really
yes big time
Clear selection
I am open to feedback from those that truly care about me
not really
big time
Clear selection
3 highlights from the past season have been...
What are the blocks? (vent here with no need to explain anything. List the real blocks and the ones that sometimes pop up in your mind, even made up ones, in the end they all have impact so its good to name them)
Activities that I do to raise my vibration, mood and confidence are...
What are some skills, potentials, interests that you carry?
The gifts I have to offer the world are...
What I learn will benefit me and my community because...
Who can I buddy up with and share my goals, obstacles, and visions with that will support me in my highest fulfillment?
I would like the facilitators to know...
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy