Application Form for the 1:1 creative support program
Name
*
First Name
Last Name
Email
*
example@example.com
Pronouns (some examples of pronouns: she/her, they/them, he/him, or another pronoun)
*
Cell Phone Number
*
-
Area Code
Phone Number
Tell me a little about yourself and what your life is like right now.
*
Why are you interested in this program? Please include a little about your relationship with your creativity, what you're struggling with right now, and what your creative project is (it's okay if it's an idea you haven't started yet!)
*
What are you hoping to get out of this program? What would success look like for you after our time together?
*
Is there any reason you can think of that this program might not be a good fit for you?
*
Do you have any questions for me about the program?
*
When would you generally be available for our 90-minute Zoom sessions? (ex. weekday afternoons, weekend mornings, weekday evenings, etc.)
*
Should we decide to work together, which payment option are you interested in? Please indicate below from these options: pay in full, two payments, three payments, or four payments.
*
Submit
Should be Empty: