📝 Registration

Email

example@example.com

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Have you registered for a Success Accelerator workshop/program in the past?

Note: If you haven't completed a registration form before, please select "No". If you're registering for multiple, just select "No" for the first one.

Preferred Name

If it differs from your legal name

What pronouns do you use?

Example: she/her, he/him, they/them, etc.

Date of Birth

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Referred by (please include the organization and name of the person)

Email of referral person

example@example.com

Which of the following do you identify with?

What is your highest level of education?

Which of the following options best describes you in the past three months?

Other

Which work/program did you want to register for?

What questions do you have about negotiating your employment?

This is your chance to get expert advice on YOUR specific situation. Fotini has heard it all and there are NO silly questions!

Why does this program interest you?

Which Wellness Workshop would you like?

Which EQi-2.0 assessment report type would you like? (The language for each respective report would be geared towards either workplace or school setting)

Other

As you explore the EQ-i 2.0, think about how active it is in your life. Check the appropriate box. Low, Mid-Range, or High for each competency. Low activity does not necessarily mean low skills, and high does not necessarily mean refined ability.

Rows	Low	Mid	High
Self-Perception
Self-Expression
Interpersonal
Decision Making
Stress Management
Well-Being (Happiness)

Do you have access to a smart phone with internet access?

Other

What interested you about this coaching/counselling opportunity?

What is it that you really, really want to create in your life, and why?

What is holding you back from getting there?

Fear, habits, insecurities, time, people, etc.

How would your life feel and what will it look like when you get there?

List your top 3 most important goals that will support moving towards your desired future.

Specifically which personal qualities, habits, and behaviors do you want to develop to help you reach these goals?

What are you willing to commit to in order for you to realize your goal?

Is there anything else you'd like me to know about you?

What questions or concerns do you have?

Current Job Search stage

What types of roles interest you?

Top job search challenge

Which sessions are you most interested in?

Which areas of life would you like to focus on in your goal-setting journey? (Select all that apply)

Other

Please confirm if you'd join us in-person on Saturday April 25, 2026 at Fairview Library

Other

Please share when you would be able to confirm by, and let us know if there's anything we can support you.

Would you like to join for lunch

Do you have dietary restrictions?

Would you request for reimbursement of transportation expenses? (eg. public transit fare)

How much reimbursement are you requesting?

Please note, we have a small budget for this, and you will not be reimbursed unless approved in writing by email.

Do you have any accommodation request?

Please let us know if you plan to bring a child along, require accessibility accomoodation, or anything else that would make your experience better.

Please confirm your mailing address for the materials you need associated to this program

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Types of Government Assistance are you currently receiving

List your top 3 most important goals that will support moving towards your desired future.

What would you like the youth support to know about you?

Setting intention, what are you hoping to get out of attending this workshop/program?

Please take your time and be specific, this is for yourself and for us to support and to match you with like-minded peers

Have you taken any workshop related to this topic in the past?

Other

Are you committed to attending the program and showing up for yourself? (This means completing the assignments, attending all the sessions, and always be in communication if you're unable to)

Other

Which MasterClass(es) are you most looking forward to

You can share the name of the instructor, topic, or the specific class

If selected, which of the MasterClass topics would you like to join a discussion in?

Do you agree to completing reports to share how you've benefitted from accessing MasterClass every 4 months?

Other

Please confirm

Sign up for SMS

Signature

Is Client?

What is one thing you'd like to accomplish this year?

Describe it in as much details as you could. By making this declaration, you're already the top 20% of the general population.

📝 Registration

By continuing with this application, you agree to the following terms and conditions: