Application Form

1

Are you interested in feeling confident and connected in any social setting for the rest of your life?* This field is required.

YESNO

2

"This year, I want to..."* This field is required.Select all that apply.

Feel more confident in social situations

Be able to make friends more easily

Express myself without overthinking

Stop feeling like I have to “perform” to be liked

Build deeper, more meaningful relationships

3

"I'm tired of..."* This field is required.Select all that apply.

Second-guessing everything I say

Feeling left out or invisible

Avoiding conversations because I don’t know what to say

Playing small in group settings

Being seen as quiet when I know there’s more to me

4

"I've tried..."* This field is required.Select all that apply.

Forcing myself to go to social events hoping it would get easier

Watching endless YouTube videos about confidence or charisma

Practicing lines or things to say ahead of time

Talking more, but still feeling like I’m not really connecting

Just staying quiet and hoping someone else will include me

Nothing, I’ve never really tried to fix this

5

"I'm ready to..."* This field is required.Select all that apply.

Finally do something about this

Learn how to communicate with confidence

Be around people who get me

Stop doing it all on my own

Take the first real step toward change

7

Click Next & Finish The Last Questions
To See If You Qualify

After you submit this application it will be immediately processed to see if you qualify for a 1:1 Social Confidence Assessment.

Thank you for sharing your insights, you should be proud of yourself for taking the first step.

8

Name* This field is required.

First Name

Last Name

9

Email* This field is required.

example@example.com

10

Phone Number* This field is required.

Please enter a valid phone number.