Rise Unlimited™ Application

1
What is your full name?* This field is required.
First Name
Last Name
2
What country do you live in?* This field is required.
United States
Another country
3
Which country?* This field is required.
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
4
Due to new international restrictions, our programs are not presently available in your country. Thank you for your interest and understanding. We highly recommend that you work with a local licensed mental health professional. Also consider visiting betterhelp.com to work with a therapist online. We wish you well on your recovery journey.
5
What is your best email address?* This field is required.
example@example.com
Confirm Email
6
What is the best phone number to reach you?* This field is required.Include country code if outside the U.S. Phone or WhatsApp is fine.
7
In your own words, what symptoms have you been experiencing?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
8
How long have you been dealing with these symptoms?* This field is required.
Less than 30 days
1 to 6 months
6 to 12 months
1 to 3 years
3 to 5 years
5 years+
9
What have you tried so far to recover?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
10
How familiar are you with Jordan's content and recovery approach?* This field is required.
I am very new and have only recently come across his content
I have watched a few of his videos and have a basic sense of his approach
I have followed his content for a while and understand his recovery approach fairly well
11
What do you do for work?* This field is required.
12
Are you able to financially invest in mentorship if it feels like the right fit for your recovery?* This field is required.
Yes
No
13
In your own words, describe your financial situation/ability to invest in this transformation of becoming symptom free* This field is required.
14
Our mentorship requires a financial investment. Please receive support through our free YouTube videos for now.
15
I understand that if I book a call and no-show without notice, I will lose the opportunity be considered for mentorship in the future* This field is required.
Yes, I understand
16
Which video made you decide to apply?
Title or a rough description is fine — 'the one about...' totally works
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