R3 Application Program * R3- Your True Nature ROAR: Exclusive Mentoring Program Name * First Name Last Name Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country What would you like to grow or overcome the most within yourself or your life? What is your profession? Do you own your own business? What is your vision for the next 12+ months? Why is your vision important to you, to others and to the world? What has stopped you from achieving this vision/these goals previously? Are you interested in investing in mentoring/counselling or coaching to help you make your vision a reality? yes no Have you invested in mentoring/counselling/coaching in the past and if so what was the value of the investment? * No Under 5K 5-10K Over 10K I understand that R3-Your True Nature and ROAR: Exclusive Mentoring Program is a 5-figure investment. Are you interested in making this level of investment in your vision? * Yes No How did you hear about Dawn and or her products or services? * On a scale of 1 to 5, rate each statement to indicate how much you disagree or agree with each of the below statements. I have a difficult time dealing with stressful experiences. Strongly Disagree Disagree Neutral Agree Strongly Agree I usually come through difficult times with little trouble Strongly Disagree Disagree Neutral Agree Strongly Agree In an emergency or stressful experience, I have people I can reach out to for support. Strongly Disagree Disagree Neutral Agree Strongly Agree In stressful times I tend to isolate myself from others. Strongly Disagree Disagree Neutral Agree Strongly Agree I believe I can grow in positive ways by dealing with difficult situations Strongly Disagree Disagree Neutral Agree Strongly Agree I find myself feeling overwhelmed and it is affecting me (e.g., sleep, focus, motivation, energy etc.) Strongly Disagree Disagree Neutral Agree Strongly Agree Regardless of what happens to me, I know that I can control my reaction to it.h. I feel out of control at times, as though the world is against me. Strongly Disagree Disagree Neutral Agree Strongly Agree I take a positive attitude toward myself and I am overall satisfied with who I am. Strongly Disagree Disagree Neutral Agree Strongly Agree I would like to have more respect for myself. Strongly Disagree Disagree Neutral Agree Strongly Agree I tend to disapprove and judge my aws and inadequacies. Strongly Disagree Disagree Neutral Agree Strongly Agree I work toward being loving towards myself when I feel emotional pain. Strongly Disagree Disagree Neutral Agree Strongly Agree I often see myself as a failure and tend to criticize myself. Strongly Disagree Disagree Neutral Agree Strongly Agree When I am going through a difficult situation, I give myself the care and compassion I need. Strongly Disagree Disagree Neutral Agree Strongly Agree Is there anything else you would like us to know about you or that you would like to share? Thank you!
