Tiffany Landry's 1:1 Coaching Application for The Autistic Mentorship.

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Welcome! This application helps me know what you're looking for support with, where you are at currently & what types of support you're seeking. If filling this out doesn't feel accessible (or you just dislike filling out applications), feel free to email me at tiffany@tiffany-landry.com to let me know you're interested in exploring if working together would be a good fit, what you're seeking support in and we can e-mail or voice message. If you'd like more information about my coaching program (including prices and what's included) you can find that here or scroll down to the bottom of the form.

All of you is welcome here! The more honestly you share here, the more it helps me to understand whether my 1:1 program would be a good fit for you. Filling out this application doesn't guarantee that we will work together nor does it lock you into working with me. This application is a way to explore if coaching with me is a good fit for both of us. If it feels like a potential good fit, I'll reach out via email and we can schedule a Feeler Call or talk via audio messages so we can feel into together whether working together would feel safe, doable and ideal for both of us. I'm so glad you're here.

Email *

First & Last Name *

Pronouns *

How did you find out about me? *

Phone number *

Age *

Have you ever worked with a therapist or coach before? *

Yes

Are you feeling stuck in some area of your life currently? *

Yes, there is one particular area I'm feeling stuck with

Yes, there are a few areas I'm feeling stuck with

Sometimes and/or somewhat

What areas of your life are your desiring support in? (Check all that apply.) *

Coming out later in life

Being late diagnosed (including self-identified) as autistic

Queer sexuality & dating

Coming home to my authentic self

Trauma Resolution

Nervous system support & regulation

Sexual healing & empowerment

Autistic support (including unmasking, unpacking internalized ableism, creating a life that is supportive)

Required

Tell me more about what you're struggling with in the areas you desire support? There's no such thing as TMI here and it's also okay to only elaborate to the degree to which you feel comfortable. *

Out of all the things you want support with, what feels like the most important/what you most want to address in our work together? * *

What do you most desire to achieve through our work together? *

How do you want to feel at the end of our time together? *

What makes you feel excited about working with me 1:1? *

Are there any relevant health concerns that you want me to know about? *

My coaching is a mixture of somatic trauma resolution tools, nervous system health & regulation, queer healing tools and queer & neurodivergent education and support. So I can best support you, what kind of support are you most interested in receiving. *

Give me the beautiful mix of body based healing & verbal processing.

I'm more interested in practical support through verbal processing.

I'm more interested in education and support

I'm not sure and would like a chance to explore it all and make adjustments based on what feels right for me.

In an effort to make my work my accessible I am offering a sliding fee scale for this offer. I ask that you be in integrity and honesty choose the tier that accurately reflects your financial situation. To support my own financial income I have a certain amount of spaces available for both The Middle Rate and The Scholarship Rate. Please be mindful that if you purchase a price at the lowest end of the sliding fee scale when you can truthfully afford The Standard Rate, you are limiting access to those who truly need financial accessibility. Please see my website for a breakdown of each rate. The 5 month package includes: 1 (75 minute) Intake Session, 3 (75 minute) sessions a month for a total of 13 regular sessions, one Celebration Call (75 min), a personalized coaching map written just for you, two bonus 30 min check in calls, post recap & practices sent via email 48 hours post session. *

The Standard rate: $3,000 USD or $500/6 month payment plan. This is the actual cost of the program and is for you if you have some financial stability, personal savings, own property or rent a higher end property, are able to pay for “wants” without checking your bank account and spend little time worrying about your financial needs.

The Middle Rate: $2,802 USD or $467/6 month payment plan. This is the rate for you if you have a steady income but are struggling to conquer debt, build savings or move away from paycheck to paycheck living. You aren’t spending the majority of your time worrying about meeting your basic needs (such as food, housing, child care.)

The Scholarship Rate: $2,400 USD or $400/6 month payment plan. The Scholarship Rate is for you if meeting basic needs takes up your budget and paying for this program would cause financial stress and hardship for you. If you struggle to pay for things like housing, food, health care, child care and are living paycheck to paycheck-this is the rate for you.

The above rates would still cause financial hardship for me, can you email me about The Intro Coaching Package (3 sessions for $600).

For applicants who feel like a potential good fit I like to offer a free 60 minute feeler call. This is a call where we have the opportunity to connect, for you to share more about what type of support you're seeking and for both of us to feel into if it would be a good fit working together. Would you be interested in this? *

Yes, I would love a free 60 minute phone call to see if this feels like a good fit and the kind of support I'm looking for.

I'd prefer to talk about it via audio messages or text messages on Voxer or Whatsapp.

Can we e-mail about it?

If you live in the U.S. we'll have our Feeler Call via an audio phone call. If you live outside of the U.S. we'll have our Feeler Call via WhatsApp. Where do you live? *

I live in the U.S.

I live outside of the U.S.

I'm not interested in a Feeler Call. I prefer to talk via Voxer or email.

Anything else you want me to know?

Send me a copy of my responses.

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