Registration: Self-Mastery, Positive Intelligence®
Positive Intelligence's breakthrough, research-based tools strengthen the part of your brain that serves you and quiet the part that sabotages you. You handle life's challenges with a more positive mindset, and less stress. We call this mental fitness.
Email
*
example@example.com
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Have you attended a Success Accelerator workshop/program in the past?
*
Please Select
Yes
No
Preferred Name
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Referred by (please include the organization and name of the person)
Which of the following do you identify with?
*
Involved with the Justice System (means a history with the criminal justice system and/or agencies such as John Howard or Elizabeth Fry)
Experienced homelessness
Experienced mental illness (either self-identify or clinically diagnosed)
Experienced trauma
Gender-Based, Intimate Partner and Family Violence
Indigenous
In or are leaving the care of the Children's Aid Society
LGBTQIA2S+
Low Income OR on Social Assistance (Low income means an individual who ears less than $20,778 per year or $41,198 per year for a family of four, Social Assistance includes government income subsidy including EI, OW, ODSP, or Basic Needs Allowance)
Newcomer (means individuals who have resided in Canada for less than five years)
Person with a Disability (this includes any physical disability, mental impairment, developmental disability or learning disability)
Racialized (means groups of people who might experience unequal or different treatment on the basis of race, ethnicity, language, religion or culture)
Refugees
Single parent (yourself)
Substance abuse/addiction
Unemployed
None of the above
Other
What is your highest level of education?
*
Some High School
High School/GED
Some Post-Secondary
College
Bachelor's Degree
Graduate Degree
Other
Are you committed to completing the entire 7-week program
*
Yes, I am ready to quiet the saboteur voices that do not serve me!
No, but I want to give this program a try and see what happens...
Other
Do you have access to a smart phone with internet access?
*
Yes I do
Sort of, I need to share it with someone
No I don't
Other
Which cohort are you registering for?
*
Please Select
Cohort 2: Mon's 5:30-6:30pm Mar 13
Cohort 3: Tues' 7-8pm May 16
Custom Cohort
It is for 1-hour weekly for seven weeks
What do you hope to achieve by participating in this program?
*
Have you taken any workshop related to Positive Intelligence or Mental Fitness before?
Never
Yup, just one
Yes, several in fact
Other
By continuing with this application, you agree to the following terms and conditions:
If you indicated that you are referred by an organization or someone, we may share the attendance of your participation in our program(s) with the organization or person as indicated https://www.successaccelerator.ca/terms-and-conditions AND https://www.successaccelerator.ca/media-release
Please confirm
*
Yes, I have read and agree to the statement set out above and the Terms & Conditions.
Yes, I'd like to receive communication and be the first to know what's going on at Success Accelerator!
Signature
*
Clear
Submit
Should be Empty: