Application for Unleash Me ProgramPlease take a moment to fill out this application so that we can see if Unleash Me is right for you. Name * First Name Last Name Email * Phone * (###) ### #### Facebook Name Instagram Handle What attracted you to this program? What is the issue or problem you would like to see shift? * What do you really desire? * What are some of your fears? * What are some of your self judgements, criticisms, or beliefs that stop you from being fully Unleashed? * What are the limiting emotions you predominantly feel? * Judgement Resentment Guilt Shame Embarassment Fear Grudge Confusion Apathy/Numbness What does being Unleashed mean to you? * What does your most beautiful life look like? * What would your community/tribe look like? * What does your financial abundance look like? * How do you see your romantic relationships & friendships? * How do you see your family? * How do you see your health, body and well-being? * How do you see your career/passion project? * How much do you agree that it's important to Unleash? * Strongly Disagree Disagree Neutral Agree Strongly Agree What areas of your life would you like to Unleash? * Voice Dance Creative/Artistic Expression Body/Well-Being Sexuality Intimacy/Vulnerability Life Purpose/Calling Social/Friendship Financial Will you attend Unleash: Lyfe Reinvented in Austin September 23-25th? * Yes No If chosen for the 12-week course, how committed are you? * Devoted Very Committed Somewhat Committed Not At All How financially committed are you to Unleash yourself? * Committed to pay in full Committed to pay in monthly installments Have you ever done an online program before? If so, how successful were you? What worked and what didn't? Why do you want to Unleash? Anything else you would like to share with me that's on your heart? Thank you! We’ll be in touch with you soon <3