ORIENTATION & INTENTION

Full Name

Email Address

Time Zone / Location

Which offering are you applying for? (Check all that apply)

ISR 4-Week Reset

ISR 6-Week Immersion

Train With Me (Practitioner Training Waitlist)

I’d like guidance on the best fit

What is calling you into this work right now?

What emotions, desires, patterns, or challenges feel present?

CURRENT LIVED EXPERIENCE

What feels most unresolved, heavy, or persistent in your life right now?

Consider relationships, work, identity, body, spirituality, or recurring patterns.

How do you notice this showing up in your body or nervous system?

(Examples: tension, fatigue, shutdown, anxiety, restlessness, numbness, digestive issues, racing thoughts, etc.)

What have you tried previously to address or shift this?

(Therapy, coaching, bodywork, medication, spiritual practices, self-study, etc.)

What helped? What didn’t? What felt incomplete?

RELATIONSHIP TO SELF & RESPONSIBILITY

Please briefly describe a moment in your life when you met discomfort this way.

In this work, self-responsibility means taking ownership of your internal experience—your emotions, reactions, and patterns—without bypassing, blaming others, or waiting to be “fixed.”

On a scale of 1–10, how comfortable are you sitting with discomfort without immediately trying to fix it?(1 = extremely uncomfortable, 10 = very resourced and grounded)

CAPACITY, SUPPORT & READINESS

Do you currently have the time, privacy, and energetic capacity to engage deeply in this work?

Yes

No, but I can intentionally create space → Please explain briefly

Unsure → What would help you feel more resourced or ready?

Who, if anyone, could support you during this process?

How might they support you?

What makes now a meaningful threshold or turning point for engaging in this work?

PRACTICAL & LOGISTICAL AWARENESS

Are you financially prepared to invest in this work?

Yes

No, but I’d like to discuss payment plans or options

Not at this time — please consider me for future opportunities

Time Commitment Awareness

4-Week Reset: approximately 2 hours per week

6-Week Immersion: approximately 4 hours per week

Practitioner Training: varies (details provided upon acceptance)

Can you realistically commit to the requirements of the program(s) you’re applying for?

Yes

No

Additional Notes (Optional):

Is there anything else you’d like us to know as we review your application?

EXPECTATIONS & ALIGNMENT

What outcomes or shifts are you hoping to experience through this work?

(Examples: emotional regulation, nervous system resilience, trauma integration, relational clarity, embodiment, self-trust.)

How do these intentions align with a process centered on somatic exploration, personal responsibility, and relational awareness—rather than quick fixes, external validation, or surface-level solutions?

INTEGRITY & CONSENT

By submitting this application, I acknowledge that

This is a collaborative, embodied process that requires active participation, honesty, and patience.

This work is not passive or prescriptive; it invites responsibility and presence.

Acceptance is not guaranteed; I may be asked follow-up questions or placed on a waitlist.

SELF-AWARENESS & INTEGRATION

Are there patterns in your life that feel cyclical or repetitive, even after attempts to change them?

When you feel challenged, misunderstood, or emotionally activated in a guided or group setting, how do you typically respond?

After an insight, emotional shift, or meaningful experience, how do you usually integrate it into your day-to-day life?

How do you understand your role in your own healing, growth, and integration process?

If you could summarize why you are here in one sentence, what would it be?

!!!Please read before responding:

• If you are applying primarily for a future offering or waitlist, please respond to one of the questions below — choose the one that feels most relevant or alive for you right now.

• If you are applying for the 4-Week Reset, 6-Week Immersion, or Practitioner Training, please respond to all four questions.

Please respond in a few thoughtful sentences to each.

There are no right answers. We’re listening for honesty, not perfection.