Application for Chrysalis:
Women’s Rite of Passage Journey

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Name*

Email*

Address*

Phone*

What are the best days and times to contact you in the coming week?*

What is calling you to join this Women’s Rite of Passage Mentoring Group?*

Tell me about the transition you find yourself in. What is wanting to fall away? What are you ready to call in for yourself?*

What is your present occupation and career background? (If you have a website, please give us your URL, so I can learn more about you)*

What has brought you the most happiness and joy in your life?*

What do you think is your biggest obstacle to making the changes you want to make?*

What do you feel is your biggest struggle with feeling more fulfilled?*

What are the top outcomes you want to achieve if you are accepted into this Women’s Mentorship Program?*

On a scale of 1–5, rate the following statements:

I am HAPPY with my life today*

Please enter a number from 1 to 5.

I am COMMITTED to living a GREAT life*

Please enter a number from 1 to 5.

I am OPEN to a quantum leap*

Please enter a number from 1 to 5.

I have a desire for greater SUCCESS*

Please enter a number from 1 to 5.

I am willing to APPLY MYSELF to reach my goals*

Please enter a number from 1 to 5.

Are you ready and able to put in the time required to step into a more authentic, fulfilling life?*

Yes

No

Are you available to travel to Maui, Hawaii for an in-person Retreat at a fabulous private Estate Feb 25 - Mar 1?*

Yes

No

I have the financial resources available for the investment in this program ($3800 for the in-person program, meals included, does not include accommodations and travel or the Online Temple, $ 2,600). $400 off for returning sisters. Payment plans available.*

Yes

No

How do you see your life changing after completing this Women’s Mentoring Program?*

If your life was everything you wanted in 5 years, how would it be different from today?*

Please share anything else you would like me to know about you!