Application For Access
This short application helps us determine whether Life Impacts Work is a good fit for your organization.No employee details required. No commitment or obligation.
Company Name
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Your Full Name
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Your Role/Title
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Approximate number of employees:
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Industry
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Alignment Check
These statements help confirm alignment in how we think about employee support. (Select all that apply)
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We recognize that personal life stress can impact focus, performance, and engagement at work
We understand that performance challenges are not always about skill or effort, but often influenced by life circumstances outside of work
We acknowledge that employees don’t fully compartmentalize stress — what happens outside of work can affect how they show up
We believe that supporting employees through real-life disruptions is an important complement to traditional wellness or productivity benefits
We value solutions employees can access privately, without disclosure, explanation, or stigma
We are open to proactive, preventative support — not only reactive solutions after issues escalate
NONE
How are decisions like this typically made at your organization?
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I make the decision
Committee or team decision
Requires executive approval
Anything else you’d like us to know?
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
SUBMIT
Should be Empty: