LiveSteady Program Application
Filling out this form will serve as securing a spot on our waitlist. We will reach out in advance with the class schedule.
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Are you 18 or older?
*
Yes
No
Do you currently live in a rental home?
*
Yes
No
If "no," please explain:
Do you live in Oklahoma County?
*
Yes
No
What is your monthly income?
*
Under $1,000
$1,001 - $2,000
$2,001 - $3,000
$3,001 - $4,000
Over $4,000
What is your household size?
*
1 person: Just me
2 people
3 people
4 people
5 or more people
If there are children in your home, how many are under the age of 18?
*
1 child
2 children
3 children
4 children
5 or more children
I do not have children
Shelterwell's classes are taught online. Do you have access to high-speed internet and a smartphone, computer, or tablet?
*
Yes
No
There is a workbook that accompanies the online lessons. Would you like a PDF version of the workbook or a mailed copy?
PDF version sent to my email.
Mail me a workbook.
How did you hear about us?
Tell us why you're interested in going through the LiveSteady Program?
Let us know what time of day you are available to go through the program. (The program is usually taught over 3 days with 2-hour sessions.)
Submit
Should be Empty: