Self Mastery Program Application

Your Name (required)

Your Email (required)

Your Phone # (required)

Your Address (required)

Your Date of Birth, ex: 04-27-1997

How did you here about this program?

I am interested in taking this program
for personal growthfor expanding my professional skillsBoth

Please note your highest academic training level and any additional growth training you have experienced

Are you currently or have you ever been in an ongoing counseling or psychotherapy relationship? Also, please note any medications you are taking for mental health and balance.

Are you actively practicing a spiritual path at this time?

At this point in life, what do you consider to be your greatest strength?

Your greatest challenge or weakness?

Your passions or fondest dream?

Are you aware of specific forgiveness issues you want to work on?

What gifts do you bring to a group learning situation?

What concerns do you need addressed in order to be comfortable in a group?

Do you have other thoughts about why this program is just right for you?