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Phoenix Rising Application
I'm so glad you're interested in joining Phoenix Rising: A Divorce Empowerment Collective!
Please fill out this form to the best of your ability. It's important that you're thorough so I get a clear sense of how you'll fit into the collective.
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Email
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Your email
Please check to indicate that you understand that Phoenix Rising requires a six-month commitment, and that refunds and cancellations are not available. The cost is $197 per month and I am able to make the financial commitment at this time.
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I understand and agree
Required
Name
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Your answer
How old are you?
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Your answer
Current marital status
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Divorced
Separated
Separated, but living together
Married
Other:
Duration of marriage or relationship
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Your answer
Date of Separation
MM
/
DD
/
YYYY
Children: Names, ages, and any information I should have about them (diagnoses, etc.)
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Your answer
Current custody arrangement
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Your answer
Do you work outside the home? If so, what do you do?
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Your answer
Are or were any of these present in your marriage or relationship?
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Infidelity
Addiction
Physical abuse
Emotional abuse
Financial abuse
Sexual abuse
Verbal abuse
Spiritual or religious abuse
Cyber abuse
None
Other:
Required
If you checked any of the above, please explain.
Your answer
Please describe your ex: profession, addictions, personality traits, etc. If you were to do a psychological profile of them, what would you say?
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Your answer
Please provide a brief summary of your divorce journey so far.
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Your answer
If you're currently working with an attorney, do you feel that they understand your divorce and that they're well-suited to your particular concerns? Please explain.
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Your answer
Are you and/or your children currently in the care of a mental health professional (therapist, psychiatrist, etc.)? If so, do you feel that this professional understands the complexities of your situation?
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Your answer
How would your best friend describe you?
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Your answer
What are your strengths and weaknesses?
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Your answer
Is there anything else you think I should know?
Your answer
I understand that coaching can be a difficult process that may require the additional support of a therapist or other mental health professional. By checking this box I am agreeing that I have a therapist and/or access to one should I need additional mental health support, or should Kate recommend this as a necessary step in our process.
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I understand and agree
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