Biography

Thank you for registering for the Balanced Spirituality Online Course.
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Name *

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Last

Email *

Age *

Please write a little about your life. (Occupation, Family, Interests, Activities, Volunteer work, etc.) *

What are some current issues you are working through? What habits or patterns are you currently struggling with? *

Share a little bit about your spiritual journey thus far. (Factual history or spiritual experiences) *

How is your physical health? Are you familiar with healthy lifestyle habits and which ones do you regularly engage in? (Organic eating, exercise, yoga, vegetarianism, massage, etc.?) *

Are you currently on any mood or psyche altering prescription medication? If so, please provide a diagnosis or background which required the use of these medications. *

What are your intentions for taking this course? How do you envision yourself evolving and in what ways? (Example: becoming more open-hearted, peaceful, charitable, etc.) *

How do you see your life unfolding through the next 10-20 years? What plan do you have in action to achieve or alter it? *

Please upload a recent (within a week), un-edited picture of yourself *

Max file size: 20MB

By checking this box below I agree to the terms of the liability waiver *

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Thank you for registering for the Balanced Spirituality Online Course.Please complete the form below

Thank you for registering for the Balanced Spirituality Online Course.
Please complete the form below