Apply to The Challenge Group
This application is to ensure that all members are the right fit for the program.  Please complete the entire form to be considered for a spot in "The Challenge" 
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Email *
Name *
What is your top relationship goal? *
Required
Tell me honestly, why haven't you achieved your goals so far? *
Describe your dream outcome regarding your ideal relationship. *
On a scale of 1-10, how willing are you to make a change right now? *
Cell Phone Number *
Do you have Previous Counseling or Coaching Experience *
Required
Do you meet people for romance online, in-person, or are you intentionally single to focus on yourself? Explain your answer. *
Activiites, hobbies, books you've read, events you attend *
How would you rate your physical health? *
How would you rate your emotional health? *
How would you rate your mental health? *
How would you rate your financial health? *
How would you rate your spirtual health? *
Which option works best for a weekly group support video call?  Select all that apply. *
Required
Your final step to become a member of the challenge is to reserve your spot in the program.  Click howtogetovermyex.com now to save your spot as we review your application. *
A copy of your responses will be emailed to the address you provided.
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