Tell Me About Yourself

First Name

Last Name

Required

Email:

(This is how you'll be notified if you've been accepted to the program)

Are you a 1st generation daughter of immigrants or a woman of color?

(All female identifying persons are welcome)

I'm first generation, my parents are immigrants

I'm a woman of color (Native, Black, Indigenous Latin/Hispanic, Asian, Pacific Islander)

Both

No, but I still want to work with you!

If not listed - please share how you identify

Other

How Are You Feeling Now?

Do you struggle with any of the following?

Check all that apply:

OVERWHELM: Extreme level of stress where emotions and thoughts are too intense or frequent to handle so you shutdown (go silent, space out)

ANXIETY: A feeling of worry, nervousness, or uneasiness about a current or future event where outcome is uncertain

OVERTHINKING: You intellectualize your decisions and/or feelings, or think of so many possible outcomes it paralyzes you and stalls your progress

STAYING SILENT: You suppress concerns, avoid asking questions or confrontation

FEELING LIKE A BURDEN: You don't want to "bother" those around you and feel like an inconvenience, even when others offer to help?

I don't struggle with any of these

Other

On a scale of 1-10, how great is your desire to transform your current situation?

There's plenty of coaches you could work with, and I'm so glad you chose to apply to "Breaking Up With Burnout"! What motivated you to apply to this program particular?

Please share

Our Work Together

Lasting change won't happen overnight, but the science-backed teaching you'll learn have shown past clients results in about 2 weeks. Are you committed to gifting yourself 60-90 minutes of "me time" to learn and integrate the teachings and somatic practices?

Pick One

Yes, I can commit to that!

No...I'm not willing or able to find the time for that right now.

Other

This program is committed to your transformation at the emotional, mental, and somatic level. Are you able and willing to invest in the high hundreds to low thousands towards education and support to heal your nervous system and widen your window of tolerance?

Pick One

YES! I'm ready to invest in personalized support for an easier way forward.

Maybe... I'm in charge of my money and spending but need more information on payments..

Maybe... I'm not in charge of my money or spending, I need to discuss with my partner.

I want to, but I'm not ready to make this financial commitment - YET.

No, I 'm not ready to make this financial commitment to improve this area of my life.

What is the #1 goal that you want to accomplish in the next 6 months?

Please share

BREAKING UP WITH

BURNOUT

Tell Me About Yourself

How Are You Feeling Now?

Our Work Together

Let's chat!

If you'd like to reach out directly or have any questions, just reach out and say hello! :)