Effective Listening | Transformative Personal Growth & Empowerment

Questionnaire

Effective Listening Group Application

Thank you for your interest in Effective Listening.

We work hard to ensure that everyone who participates in Effective Listening groups is a good fit for the process, and that each group is composed of a mix of people that will work well together.

To do so, we need to get a very good sense of what you're like, and that's pretty hard to do without actually meeting you. Some of the questions below are very personal. The more fully and honestly you answer them, the better.

My hope is that the application process itself will be interesting and informative for you.

If you prefer to have a 1-1 meeting (via Zoom) instead of doing this application, we can arrange to meet for a 50-minute interview for a fee of $200. Please note that putting in this application or arranging a 1-1 meeting does not guarantee a spot in a group.

Thank you! 🙏

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How did you hear about Effective Listening?

What are your current life goals, priorities and plans?

What are some of your strengths as a human, and some of your shortcomings?

What are some of your identities or social roles that are important to you?

Social media accounts associated with you that would give me a sense of who you are

Please tell me a bit of your life story and how it brought you to Effective Listening in this moment.

What are you hoping to gain from your participation in an Effective Listening Group?

Do you currently use drugs or alcohol?

YES

If Yes, Please Elaborate

Have you been diagnosed with any psychiatric condition(s)?

YES

If Yes, Please Elaborate

Are you currently taking any psychiatric medications?

YES

If Yes, Please Elaborate

Have you ever attempted suicide?

YES

If Yes, Please Elaborate

Anything else you want me to know?

Name

Preferred Pronouns

Phone

Preferred method of contact