Targeted Podcast Guest Application

Do you think you might be ready to tell your story?*

(Yes, no, and maybe are all acceptable options and you may change your mind at any time)

Name (pseudonym is fine, but let us know what to call you)

First NameLast name (if desired)

Email*

example@example.com

Please answer these questions so that Mo Blackwell will understand a bit about your story and why you might be ready to share it. Whether or not you end up as a guest on the podcast, always remember that your story is important and YOU MATTER. There are many reasons why the podcast might not be a good fit for you, but the most common one is that we are concerned that it might not be emotionally healthy choice for you right now.

Are you a survivor of abuse? If so, please give a brief explanation *

(such as survivor of spousal abuse, survivor of child abuse, current victim of elder abuse)

This question is hard, but can you briefly explain your situation? *

Everyone's story is important, whether it was a one-time abuse or years of consistent abuse. Everyone's story is precious and we respect each one. It is helpful, though, for us to know basic details before we speak with you directly.

Why do you want to be on the show?*

Do you have at least one strong support person in your life who can be with you after you share your story? *

A support person could be a counselor, a good friend, a family member, etc...

If you do have a support person, have you discussed your desire to share your story on the podcast?*

Will you be in danger if you are on the podcast?

Why or why not?

Thank you so much; we will be in touch.

Please be aware that it may take a while before we can be in contact with you as the podcast generally records interviews in the fall and the episodes air in the winter.

website

Apple Podcast Link