Bloom Again Life Coaching Workshop Application

Bloom Again Life Coaching Workshop
Participant Application Questionnaire

Thank you for your interest in the Bloom Again Group Life Coaching Workshop - an 8-week journey of healing, rediscovery, and empowerment after divorce. Please answer the questions below with honesty and openness. All responses are confidential.
PERSONAL INFORMATION
1 Full Name
2 Date of Birth

MonthDayYear
Date
3. Phone Number
4 Email Address
example@example.com
5 CityState of Residence
6. Preferred Method of Contact: Phone Email Text
Phone
Text
MARITAL & FAMILY BACKGROUND
7 How long were you married
8 When did your divorce finalize or what stage are you in
9 Do you have children If yes what are their ages
10. Are you currently in any romantic relationship(s)?
PERSONAL READINESS & GOALS
11 What inspired you to apply for this workshop
12. How would you descripbe your current emotional and mental state? (Check all that apply)

GrievingHealingAngryHopefulNumbReady to move forwardOther
Other
13. What are your top three personal goals for participating in this workshop?
1
2
3
14 What do you hope to learn or gain from this experience
15 Have you participated in coaching therapy or support groups before If yes please explain briefly
16. Are you able to attend all 8 bi-weekly sessions?

YesNo
17. Are you willing to commit to completing the homework assignments and self-reflection exercises?

YesNoDepends on my mood that week.
18. (For virtual only) Do you have a safe and private space to participate in emotionally vulnerable discussions?

YesNoWorking on it
19 Describe a moment when you overcame a personal challenge What did you learn from it
20 What does the phrase Bloom Again mean to you personally
21 Is there anything else you'd like the facilitators to know as they consider your application
22. The total cost of the Bloom Again 8 course program, including all books and materials, is $650. Thanks to generous local donors and amazing Divorcee Diva Alum, we are offering 10 partial scholarships worth $300 each. This means you could join for just $350 (payment plans are available) if selected. Would you like to be considered for the DD Scholarship fund?

Yes and I'll pay the remaining balance of $350 in full or via payment plan.No, I'll pay $650 in full w/o a scholarship.
Once submitted, your application will be reviewed by Coach Kim's LifeLab team. Selected participants will be notified via email or phone. If accepted, you'll receive a welcome packet with full workshop details and next steps.
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Bloom Again Life Coaching Workshop

PERSONAL INFORMATION

MARITAL & FAMILY BACKGROUND

PERSONAL READINESS & GOALS