Kaleidoscope Application Form

WELCOME!

Kaleidoscope is Life on Purpose's group coaching experience (includes six 75-minute group sessions and up to two hours of private coaching sessions) designed to help you reclaim your authentic self, reconnect with possibility, and create an action plan for a life that sparks joy and purpose!

Group session schedule:
September 11, 18
October 2, 9, 16, 30

Group sessions will be held Wednesdays from 6-7:15 p.m. PT.

Private sessions will be scheduled individually to best fit your schedule.

Program cost: $1100
or 2 payments of $575

(If you know that you want to join the group at this time but feel extremely hindered due to financial circumstances, please book a call with me to discuss alternative arrangements.)

If you have any questions, or there's anything on the application you'd prefer to talk about first, please don’t hesitate to reach out: jenwestracoaching@gmail.com.

I'm so excited to welcome you to Kaleidoscope and look forward to talking to you soon!

Jen Westra

Your Name*

First NameLast Name

E-mail*

Preferred Phone Number*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What sparked your interest in Kaleidoscope?*

What would you love to be different at the end of the program?*

What is (are) your biggest current challenge(s)?*

Kaleidoscope is a group coaching program. While all group members agree to maintain confidentiality, coaching can only succeed when participants are willing to be open and honest. Are you prepared and able to engage in personal, vulnerable conversations within a group setting?*

YesNo

How did you hear about Kaleidoscope?

Any other comments or questions?

Program Application