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APPLICATION TO WORK TOGETHER
*Your answers are CONFIDENTIAL and only for the purposes of guidance in the coaching program.
No answers will be shared with other members of the program, friends or family members of applicants.
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Email
*
Your email
Name
Your answer
Phone Number / WhatsApp with country code (To Text confirmation)
Your answer
Facebook / Instagram Handle
Your answer
Where in the world do you live?
Your answer
Tell me the story of WHY you decided to apply to work together? What's going on in your life that makes you ready to step into your most authentic masculine archetype?
Your answer
Describe your grand vision for your ideal life (anything goes!)
Your answer
What obstacles/challenges are currently in the way of you TRULY embodying your vision?
Your answer
In what ways have you invested in your personal growth in the past? Have you ever worked with a coach or therapist before? If so in what capacity, and were you satisfied with your results?
Your answer
What do you desire to achieve from working together?
Your answer
Do you have a daily personal practice? If so, what does it entail?• What is your experience with meditation and mindfulness practices?
Your answer
Have you explored altered states of consciousness? If so, in what way and with what results?
Your answer
Do you feel comfortable talking about sex, masturbation, fears, desires and other topics about sex and sexuality in a safe container?
Yes
No
Clear selection
If no, why?
Your answer
What is your current relationship status?
In a committed Monogamous relationship and happily fulfilled
In a committed monogamous relationship, and desire to leave
In a committed monogamous relationship and want to open it up
Single and not desiring partnership
Single and deeply desiring partnership
Single and considering partnership
Committed monogamy and happy
Monogamy, but wanting out of the relationship
Monogamy, but desiring some element of non-monogamy
"Monogamish" (occasionally having outside or shared experiences, swinging, etc.)
Polyamorous
Clear selection
SEX LIFE In Partnership how often are you having sex?
Multiple times a day
Once a day
3-5 times per week
Once a week
1-2 times per month
Every couple of months
I don't remember the last time we had sex
Clear selection
In Partnership - how often do you desire to be having sex?
I'm happy & don't desire more sex
I'm mostly satisfied but would like to have more sex
I'm not sexually satisfied & need more sex
Frequency of sex is not important to me
Clear selection
Single - (Have Lover/Friend with benefits) How often are you having sex? (IF SINGLE WITHOUT a lover/FWB go to next question)
Multiple times a day with a lover / friend
Once a day with a lover / friend
3-5 times per week with a lover / friend
Once a week with a lover / friend
1-2 times a month with a lover / friend
Every couple of months
I don’t remember the last time I had sex
Clear selection
Single - How often are you having sex?
Multiple times a day with strangers / dates
Once a day with a stranger / date
3-5 times per week with strangers / dates
Once a week with a stranger / date
1-2 times a month with a stranger / date
Every couple of months
I don’t remember the last time I had sex
Clear selection
Single or In Partnership - Have you every paid for sex?
Yes I have many times
Yes a couple of times in my life
Yes once
No - but curious
No - not interested
Clear selection
Masturbation History I would describe my childhood & adolescent relationship with masturbating as:
I had a healthy relationship with masturbating but it was secret
I had a healthy relationship with masturbating and I was not ashamed of it
I had an unhealthy relationship with masturbating
I never masturbated
Other please explain
Clear selection
Other, Please explain
Your answer
As an Adult - How often do you masturbate?
Multiple times per day
Once a Day
3-5 times per week
Once a week
1-2 times per month
1 rarely masturbate
Other, please explain
Clear selection
Other, please explain
Your answer
How would you describe your relationship with masturbation while in a romantic partnership?
My partner honors my masturbation practice
My partner does not know I masturbate
I feel shame around SHARING with my partner that I masturbate while in partnership?
I don't masturbate when in partnership
Clear selection
How often do you ejaculate when you masturbate?
Every time
About half of the time
Almost never
Never
Clear selection
Have you ever consciously chosen to be celibate?
Yes
No
Other, Please explain
Clear selection
Other, please explain
Your answer
How would you rate your relationship with porn?
I consider myself addicted to porn
I watch porn occasionally
I don't watch porn
Clear selection
How often do you watch porn to masturbate?
Multiple times per day
Once a day
3-5 times per week
Once a week
1-2 times per month
I rarely watch porn to masturbate
Never
Other, please explain
Clear selection
Other, please explain
Your answer
Have you ever cheated on a partner?
Yes - and I told them
Yes - And I got caught
Yes - And they don't know
Almost - but I stopped before anything happened
No
Other, please explain
Clear selection
Other, please explain
Your answer
Have you ever been cheated on by a partner?
Yes - they told me
Yes - I found out
No - But I think so
No
Clear selection
Have you ever felt that you were acting in an abusive manner towards someone in a sexual or romantic relationship?
Yes
No
I am not sure
Clear selection
If "Not Sure" or "Yes" - please describe the outcome, and how you have done work around this to not repeat
Your answer
Have you ever been physically abused by your partner or lover?
Yes
No
I am not sure
Clear selection
If "Not Sure" or "Yes" - please describe the outcome, and how you have done work around this to repeat that pattern
Your answer
Have you ever been sexually abused in your life?
Yes
No
Not Sure, please explain
Clear selection
If "Not Sure" or "Yes" - please describe the outcome, and how you healed from this
Your answer
When I'm arguing with my partner, I raise my voice...
Always
Sometimes
Occasionally
Never
Clear selection
What is your current household income?
< $25,000 USD Annually
$25,000 - $50,000 USD Annually
$50,000 - $100,000 USD Annually
> $100,000 USD Annually
Clear selection
What Areas of this program are you most interested in?
Sacred Sexuality
Relationships
Understanding masculinity and childhood wounding
Cultivating your sexual energy & multi-orgasmicness
Other (Fill in below)
Clear selection
Other
Your answer
Are you ready to step into this work and powerfully embody your most authentic masculine archetype?
YES! I am ready to step into my power
Yes, But I feel a lot of fear!
I'm not sure... (please explain)
Clear selection
Please explain:
Your answer
How did you hear about my work?
Your answer
DISCLAIMER - Again - a reminder that all answers will remain confidential - No answers will be shared with other members of the program, friends or family members of applicants.
Is there anything else you would like me to know?
Your answer
Option 1
Clear selection
PLEASE KEEP AN EYE OUT FOR AN EMAIL FROM **MATTHEW AYRISS **
Your answer
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