Unmasked Program Course Application
Apply to join the 6-week Unmasked program. Please answer honestly and only share what feels comfortable for you.
Welcome.... Thank you for you application
Thank you for your interest in Unmasked — Regulated, Real & Resilient.This short application is a gentle way for you to share a little about yourself and what’s bringing you to this work. It also helps ensure the program feels like the right fit for where you are right now.There are no right or wrong answers — simply share what feels comfortable.
Section 1: Basic Details
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (0000) 000-000.
Section 2: Intentions & Readiness
What has drawn you to the Unmasked program at this time?
*
What are you hoping to gain or experience over the 6 weeks?
*
On a scale of 1–10, how ready do you feel to explore yourself in this way?
*
Not ready
1
2
3
4
5
6
7
8
9
Very ready
10
1 is Not ready, 10 is Very ready
Section 3: Self-Awareness & Reflection
Can you share a little about what you’ve been experiencing lately (emotionally, mentally, or physically)?
Do you notice any patterns (e.g., overthinking, people-pleasing, shutting down, feeling overwhelmed)?
When do you feel most like yourself?
Section 4: Support & Safety
Are you currently working with a therapist or support person?
Yes
No
If yes, you may share details (optional):
Is there anything you feel would be important for me to know to support you safely during this program?
How do you usually respond when things feel overwhelming?
Section 5: Commitment
This is a 6-week program. Are you able to commit to attending and engaging each week?
*
Yes
No
Are you willing to approach this work with openness and self-compassion?
*
Yes
No
Which payment option are you considering?
*
Full Payment
Early Bird
Deposit
EziPay (payment plan)
Other
Section 6: Closing
Is there anything else you’d like to share?
Do you have any questions before beginning?
Consent & Agreement
*
I understand this program is not a substitute for individual therapy or crisis support
I agree to take responsibility for my own wellbeing during the program
Submit Application
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