Heal the Ages© Interview Application
Tactful Disruption® is a strategic resource at the intersection of mental health and career development related to diversity and inclusion shortcomings. We operate as a digital mental health coaching and consulting practice addressing intersections. 

Heal the Ages© is our eight-week signature program designed to support emotional wellness for creative and gifted adults interested in identity work. 

We appreciate your interest in our special offer in collaboration with DRK Beauty Healing for the May 2024 peer coaching group. *If selected to participate you will be receiving participation details for required materials to participate.
Sign in to Google to save your progress. Learn more
Email *
Are you available for the entire program? (The program is only on Monday evenings from 6:00pm -7:30pm CST) *
Required
What are you hoping to understand about yourself through participating in this program? *
How did you hear about this opportunity? *
Tell me in 1 page where you currently are in life versus where you wish to be. You may include any details you feel it pertinent for me to know.  (This information is at your discretion. Your submission is confidential and will only be discussed during your interview) *
Captionless Image
Name *
First and last name
Captionless Image
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Tactful Disruption®. Report Abuse