ADHD Women: Navigating from Chaos to Clarity

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Please fill out this form to apply for our 6-week long small group coaching engagement meeting once a week on Fridays. Once approved you will receive an invoice for $349 from empowerM3.cn@gmail.com to secure your spot. Space is limited to 12 women.

Next Group Launches Friday, April 12, 2024- 9am PT/ 9am MT/11am CT/12 pm ET.

Application Deadline: April 8, 2024

Email *

First Name *

Last Name *

Email Address *

I give permission to receive email correspondence from EmpowerM3 LLC and Coaching Brillance LLC. *

Yes

Required

Phone Number *

Time Zone *

I give permission to receive text message correspondence from EmpowerM3 LLC (859)455-6156 and Coaching Brillance LLC (320)492-7098. *

Yes

Required

Age Range *

18-25 years old

26-35 years old

36-45 years old

46-55 years old

56-65 years old

66 years old and beyond

Occupation *

What is your experience with ADHD? *

Diagnosed ADHD as a Child

Diagnosed as an Adult/ Late Diagnosis

Undiagnosed/I suspect I have ADHD

Other

Required

Where did you find out about this group? *

Facebook

Instgram

Other Social Media; Nextdoor, Alignable

ADHD Coaches Organization (ACO)

Local Provider

A Coach

Word of Mouth

Printed Flyer

Other

Required

What is your greatest challenge living with ADHD currently? *

What support have you used to help you? *

I am currently working with a therapist.

I have done therapy in the past.

I am currently working with a Coach.

I have worked with a Coach in the past.

None

Other:

Required

What do you hope to get out of this group coaching engagement? *

Send me a copy of my responses.

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