Beautifully Broken™ Group Application
Thank you for your interest in the Beautifully Broken group.This is a safe, Christ-centered space designed to support women navigating the heartbreak of intimate betrayal. This short application helps ensure the group is a good fit and allows me to support you well.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Current Situation:
What brings you to the Beautifully Broken group today?
*
Where You Are Right Now
Which of these feels most like where you are right now?
*
I just found out, and my world feels upside down
I'm in the middle of this. I feel overwhelmed and emotionally exhausted
I've been carrying this for a while, but still feel stuck and/or unsure how to move forward
I've started the healing journey, but know I still need support and guidance
Other: (Please share)
What You're Hoping For
What are you hoping to gain from being part of a group like this?
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Group Fit
This is a small, confidential group that includes sharing, reflection, and personal growth.
Are you open to participating in that kind of environment?
*
Please Select
Yes, I'm open to that
I think so, but I'm not sure yet
I don't think this is the right fit for me
Support System
Are you currently receiving any form of support?
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Counseling/therapy
Support Group
Trusted friend or family member
Church or other community
None
Participation & Privacy
Group meetings are held in a private Zoom room and are designed to be a safe, confidential space. Participants are expected to join from a private location, have their camera on during sessions, use headphones or earbuds when possible to ensure conversations cannot be overheard and for your own safety.
Do you have access to a space where you can participate in this way?
*
Please Select
Yes
I believe so, but may need to make arrangements
Not currently
We can talk about how to make this work for you.
Readines & Commitment
This group is designed to be a consistent, safe space for healing and growth.
Are you willing to show up regularly and engage in the process?
*
Please Select
Yes, I am open to that
I think so, but I may need some clarity
I'm not sure yet
If you're unsure, that's okay--we can talk through what this would look like
Anything Else?
Is there anything else you'd like me to know as I reviw your application?
Before you go...
Would you like to receive encouragement, resources, and weekly updates (including my podcast and blog)?
*
Yes, I'd love that
Not right now
Thank you for taking the time to share your heart.
If it feels like a good fit, I’ll reach out with next steps.If not, I’ll do my best to guide you toward the right support. 👉 You’re not alone in this.
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