Be Free and Be Whole Mentorship Application
This form is the application for the 'Be Free' and 'Be Whole' wellness and mentorship program with Kiara Norwood, M.A., Alternative Wellness Therapist of Energetically Aligned Healing. You will be contacted after the completion of this application with further steps. Kiara can be reached at kiara@knorwoodwellness.com or 619-614-6127 with any questions or concerns.
Email *
Name *
Address *
Phone number *
Age *
What led you to apply to this mentorship program? 
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What are you hoping to accomplish in working with Kiara as a coach and mentor? 
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What work have you already accomplished on your healing journey?  
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Have you worked with a coach, therapist, guide or other professional healer previously? If so, please provide as much detail as you feel comfortable about those experiences. 
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How would you describe the place or stage you are currently are in in your healing journey?  
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How would you describe your current level of mental, emotional, spiritual, and physical health? Please provide as much detail as you feel comfortable.  *
What do you feel are your greatest strengths? 
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What do you feel are your greatest areas for growth? 
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I understand that alternative wellness, coaching, mentorship, tarot/oracle card readings, reiki, numerology, hypnotherapy, and/or herbalism are not a substitute for clinical mental health therapy, psychiatric care, or standard medical treatment. I affirm that I am not currently experiencing a crisis or mental, emotional, or medical emergency and am not a harm to myself to or others. Please sign below: *
A copy of your responses will be emailed to the address you provided.
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