Professional Speaker Questionnaire

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We appreciate your interest to assist in our group sessions! These group sessions help our community to feel more supported in their everyday life and we couldn't do this without you!

We are on track to start our adult and youth group sessions this month. We would love to have you join the team for a great cause.

Below are questions to get an idea of how you operate, your specialty, and what you are able and willing to assist us with.

After submitting your questionnaire, it will be reviewed by our Group Session Team and they will get with you to set up a day and time to chat in more detail.

Please answer all questions, if it does not apply to you, put "N/A"

We thank you for your time and we are looking forward to hearing all about you!

Email *

First and Last Name *

Certification Title(s), if any relating to your specialty: *

Please note that we are a non profit and we aim to help the community of people with resources to live an authentic life on purpose that brings them peace. We do this through the help of community professionals, donations, volunteers, resources, active programs, etc. Please select one below. Thank you for your desire to help the community grow mentally and emotionally! *

I understand. I would love to contribute my help for free.

I understand. I would love to contribute my help for a discounted rate.

I understand. I would love to contribute my help at my full rate.

Other:

Phone Number *

Name of Practice, if any. *

What is your professional specialty or specialties that you would like to share with our group(s)? *

How long have you actively worked in your specialty? *

Do you currently provide virtual mentoring or professional services? *

Yes

Do you currently offer or administer group therapy? Click all that apply below: *

Yes, to adults

Yes, to youth

Yes, to kids

Other:

Required

Are you comfortable with people of the LGBTQ+ community? *

Yes

Other:

What is your availability to administer a 1 hour group session on a specific topic? Click all that apply *

Weekends in the evening

Once a Month

Twice a year

Once a year

Weekdays in the evening

Required

What is your speaking approach? (Direct, Story Telling, Convincing, Etc.)? *

Could you leave our attendees with something to work on after the session is over? (Homework/Action to make movement)

Yes

Other:

Clear selection

Do you have a therapist? *

Yes

Other:

What inspired you to become a professional in your particular field? *

Do you have any additional comments, group topic suggestions or anything else you would like for us to know about you?

Accepting this opportunity, what do you expect to get from this experience? Please include if you would like advertisement on our website and social media? *

Send me a copy of my responses.

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