The Clarity Fund

1

Name

First Name

Last Name

2

Email

example@example.com

3

Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

4

Phone Number

Please enter a valid phone number.

5

What inspired you to apply for the Clarity Fund?

7

What are you hoping to gain from coaching through this program?

8

Which statement best describes your current financial situation?

I’m currently experiencing significant financial hardship.

I’m managing basic expenses but have little room for extras.

I’m financially stable but coaching would still be a stretch right now.

Prefer not to say.

9

Are you currently employed or in school?

Full time

Part time

Unemployed

Student

10

Would you be open to sliding scale pricing if full funding isn’t available?

Yes, I'd love that option.

No, I can only participate if fully covered.

11

If you selected yes to the previous question, what range feels comfortable for you per session?

12

Consent/Next Steps- I understand that submitting this form does not guarantee placement - I authorize Unleashed Peaks to contact me regarding this application. - I confirm that the information I’ve provided is true to the best of my knowledge

YESNO