The Courage Collective

The Courage Collective - Intake Form

Thanks for applying to be a part of The Courage Collective! Please answer all questions as completely as you are wiling. Once submitted, I will respond to you within 48 hours.
Date

Month Day Year
Date
Name

First Name Last Name
Email address

On a scale of 1-5 (with 5 being the highest), how high would you say your level of stress right now?

	1	2	3	4	5

1 is Low, 5 is High

On a scale of 1-5 (with 5 being the highest), how high would you say your level of fear is right now?

	1	2	3	4	5

1 is Worst, 5 is Best

What is your main source of fear at the moment? (Dig deep. What's sitting heavy on your heart?)

On a scale of 1-5 (with 5 being the highest), how high would you say your level of frustration right now?

	1	2	3	4	5

1 is Worst, 5 is Best

What is frustrating you at the moment? (Even if it seems silly, name it!)
What's currently working?
What isn't working?
What's predictable for you and your life if things continue in this way?
If the current circumstances weren't a factor, how would you want your life to look?
What do you think you need?
Beyond toilet paper, a winning lottery ticket, and a clone of yourself.
If selected, what days and times work best for you to connect on a weekly basis? Select all that apply.

Mondays 4:30-5:30pm Mondays 5:30-6:30pm Mondays 6:30-7:30pm Mondays 7:30-8:30pm Tuesdays 8:30am-9:30am Tuesdays 7:30pm-8:30pm Thursdays 8:30-9:30am Thursdays 4:30-5:30pm Thursdays 5:30-6:30pm Thursdays 6:30-7:30pm Thursdays 7:30-8:30pm
How did you hear about this group and/or Meghan Johnson?
The fee to participate in this group depends on the number of participants willing to commit to the full 12-week period. Total cost for the group is $600/month, meaning it would be $60/month per person if 10 people enroll. All of this to say, the more who join us, the better! That being said, what are the names and emails of two other people who would benefit from such a group?
If you would feel more comfortable connecting me with these people in an email, that's fine, too! Just indicate that in the text box above.
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The Courage Collective - Intake Form