Intuitive Healing & Mentorship Application

Please set aside 30 minutes to 1.5 hours to thoughtfully fill out this application.

I strongly suggest cutting and pasting your answers onto a note on your computer or phone as you go so that you don’t lose your work in the event of power loss or server time out.

A note for those applying for a scholarship:

Partial scholarships are granted based on financial need and my current availability of scholarship funds with priority given to people of color and individuals from communities that have been historically marginalized and typically under-represented in counseling, somatic therapy, and alternative healing circles. If my current scholarship fund is exhausted at the time of your application AND you would otherwise be granted a scholarship, your application will be held on a waitlist for a period of four months. You will be notified if a scholarship becomes available during that time.

Please click here to read about available discounts and scholarships.

I do not offer full scholarships for my Intuitive Healing and Mentorship Program. I trust you to make an assessment about what you have the capacity to pay. I have learned along the way that if I offer my work for free, people don’t value it. I want this work to be an edge, but not take food off your table or stop you from being able to afford your home. My suggestion is to take a look at a budget calculator and see what you can really afford at this time. Truly. I want you to have access to this, and I also have to keep a roof over my own head, and food on my table.

If you are planning on requesting a scholarship, there are many free online tools that may help you look at your finances prior to filling out the application below. I provide some links to these tools on my Discounts & Scholarship page. Additionally, you can Google “budget calculator” if you need help finding one.

In addition to filling out the Mentorship Application, you can fill out the Scholarship / Custom Payment Plan Application here.

Mentorship Application

Name *

First

Last

Email *

Main Phone *

Alternate Phone

Are you hoping to work together in-person in San Luis Obispo or via video-confrencing from anywhere in the world? *

In-Person in San Luis Obispo, California USA
Remotely via Video Conferencing
A mixture of both

When do you hope to start our work together? * *//

How did you hear of me? *

Scholarship Information / Custom Payment Plan

Do you need a scholarship in order to access my services? *

No.
Yes. Without a scholarship, I will not be able to participate at this time.
Maybe. I am seeking alternative ways to generate payment and I'm not sure yet what I can do OR I have other resources I may be able to tap however this would create a significant strain on my ability to meet my basic needs.

Custom Payment Plan: Do you need an extended payment plan in order to make this work accessible for you?

Check if yes.

I typically require full payment in advance for drop-in session work. For my Intuitive Healing and Mentorship program, I typically offer a full payment or a seven-month payment plan. If you need an alternative accommodation, please check this pox.

Discovery, Goals & Visions

Big Vision: *

If this one-on-one Intuitive Healing & Mentorship Program is everything you hope it will be, how do you imagine you, your life, your relationships and/or your work will be different on the other side of our time together? How will you know how effective this has been?

Personal Goals: *

What goals do you have for your work on yourself? What is it that you really want to be and do? What are your aspirations? What do you wish you could be great at doing? Where do you want to see yourself in the next six months (Please be specific.)

Pro-Active Action: *

How much energy are you willing to put into that? What are you willing to do in the next 30 days to move you towards the direction of your dreams? What small steps can you take today to get you closer to your vision? What will you do different tomorrow to meet those challenges?

Existing Resources: *

What are you doing really well that is helping you get there? What skills, capacities, relationships, beliefs or inner tools do you already utilize to give you support, grounding, centering, release or inspiration?

Barriers for Success: *

What is holding you back? What are you not doing well that is preventing you from getting there? What are the biggest challenges, self-defeating behaviors or roadblocks you have in your life right now? What could you do less of?

Resource Development: *

In order to really live your vision & achieve your goals, what skills, or resources do you think you need to build? What might you need to heal?

Sabotage: *

What (if anything) do you find challenging (or imagine might be challenging) about showing up fully for one-on-one personal work with a supportive mentor or ally? How might you sabotage your own growth or our professional relationship?

Mentorship Relationship: *

How can I help? What do you most desire / expect from this mentorship relationship? What can I do to help you succeed?

Energy, Motivation & Passion: *

Where do you get your energy? What motivates and turns you on in your life right now? What are you passionate about?

Stress Release: *

What do you find works for you to release stress?

Pleasure: *

How do you like to enjoy yourself? What do you enjoy doing?

Challenging Relationships: *

Is there anyone in your life who regularly puts you down, criticizes you, or whom you feel you have to tread carefully around?

Values: *

What are your values or the things in life that you see as standards for your behavior or what you judge as most important in life? If you are unsure of this we will explore this in-depth as part of our mentorship process.

What am I NOT asking you that you really want me to ask? * *

Is there anything else you'd like me to know about you?

Any questions or requests you have for me? *

Please note: The State of California does not license practitioners of complementary healing arts such as Yoga Therapy, Reiki, Intuitive Healing or Counseling/Mentorship. *

Acknowledgment of non-licensure

Captcha *

What is the second letter of the alphabet?

Name