LANGUAGE ALCHEMY GROUP COACHING APPLICATION - TIER 3

Thank you for your interest in becoming a member of the Language Alchemy Group Coaching Program.

We’re excited you feel ready to take action to transform your life and relationships through conscious communication, and with personalized guidance in a supportive community of like-hearted peers.

Please answer all the questions mindfully.

Sign in to Google to save your progress. Learn more
Email *
How did you hear about this program? Check all that apply
 *
Required
Name - First & Last *
Phone number  *
Please select which weekday you prefer to join: *
What are your 2 or 3 top communication struggles at this moment?  *

Think of a relationship you would like to transform. What do you wish you could say to that person or hear from the person? 

 *

Consider a communication area or situation in which you would like to communicate with authenticity, clarity, confidence and compassion. What do you wish you could communicate or how do you wish you could communicate in that area or situation?

 *

What is one communication goal you’re willing to commit to throughout the duration of the coaching program? Be as specific as possible. It could be a mindset shift, something you’d like to say, or how you’d like your communication to impact a specific person.

 *

From 10% - 100%,  how committed are you to this goal?

*

How will you know you are taking steps towards your goal? What kinds of feedback will show you that?

 *

Why are you investing in yourself and your communication at this specific time?

 *

I’m here to teach you, support you, cheer you on, and help you take the steps to transform your communication. You are the one who will be doing the work that leads to transformation. You will also contribute to co-creating a transformative space for the whole group. This program will require you to set aside 2 hours every week.

From 10% - 100% how committed are you to practicing the communication tools you learn during the live sessions and office hours?

 *

From 10% - 100% how committed are you to having a 20-minute weekly call with a communication learning partner?

 *

From 10% - 100% how committed are you to reflecting on your communication by doing the handout or journaling exercises?

 *

From 10% - 100% how committed are you to participating in the group live sessions?

 *

We create a safe space when we share certain values and make agreements to uphold them. Please check all that you agree to.  

 *
Required

Thank you for your sincere responses!

Your application will be reviewed. You’ll hear from me, Alejandra, within 48 hours.

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

 *
TERMS AND CONDITIONS
Before you send this form, please enter your full name to indicate you acknowledge and agree to these terms and conditions:

CONFIDENTIALITY AND PRIVACY OF MATERIALS
I agree not to reproduce, sell, distribute, or otherwise provide access to any materials or oral teachings I receive from Alejandra Siroka and Language Alchemy to any third party without the express written permission of Alejandra Siroka.

REFUND & CANCELLATION POLICY
Once I receive an email from Alejandra Siroka confirming that my application has been accepted, I will receive a link to register and pay for the Language Alchemy Group Coaching Program. This program is for a small group. I understand that my payment is only refundable or transferable to a future program up to 30 days before the program starts. I further understand that my payment is non-refundable and non-transferable within 29 days before the start of the program or once the program has started, whichever occurs first. I also recognize that I am not considered officially registered until my first payment has been received.

ACKNOWLEDGMENT
My registration in the group coaching program is considered an acknowledgement that I have read, understood, and agreed to abide by these Terms & Conditions.

Fill in full name below to agree.
 *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Language Alchemy.

Does this form look suspicious? Report

Google Forms