Form | EATL Applicaton - Institute of Loving

Top 10 Essences & How to Use Them for Healing, Support, and Dealing with Common Issues

Emerging as the light
application

This is a rare and precious opportunity for you to up level in all areas of your life. The program is a 'game changer' and will teach you valuable skills that you can apply in service to your own upliftment and growth.

A $100 Application Fee is due at the time of submission.

I will review your application and will be in touch shortly.

IMPORTANT INFORMATION: Please take some time to answer the following questions honestly and openly. Your heartfelt responses will assist us in determining if you are a right fit for the program. In addition, if you are accepted into the program, the confidential information you supply below will help us to support you during our time together.

Full Name

Date of Birth

Address

Cell Phone

Date

Current Profession

What do you love about your career?

What would you like to be different?

Explain your dream job:

What are your favorite things to do outside of work that really make your heart sing?

What is sacred to you?

Where do you find the most meaning in life?

What are your biggest struggles?

Are you aware of any negative patterns that keep you stuck or small?

What areas of your life need more attention and care?

Have you ever been addicted to: Alcohol, Drugs (prescription or street), or other mood-altering substances?

If you answered “Yes,” to any of the above questions, please explain your current state of recovery and what you are doing or have done about the addiction.

Have you ever had a psychological condition that required long-term counseling (i.e., more than one-year) or hospitalization?  

If you answered “Yes,” please explain the circumstances, how long ago this happened, and any other relevant information that may apply.

Do you or anyone in your family suffer from mental illness?  

If you answered “Yes,” please indicate who and what they are diagnosed with and how it has  impacted your life.  

What is your intention for participating in this course? What would you like to accomplish by the end of the program?

What aspects of the program are you most interested in and why?

How committed are you to your personal growth?

How committed are you to completing this program?

Are there any potential issues that cause concern regarding your full participation in this course?

Do you have any impairments that would cause concern about participating in an online course?

Is there any other information you would like to share?

Acceptance

By checking this box, I voluntarily submit this application and information and affirm, understand, and agree to all the following: 1) I understand that all fees for applying to this program are nonrefundable. 2) I understand that this is a personal growth program and does not replace professional psychological services. 3) I certify under penalty of perjury that the foregoing statements are true and accurate to the best of my knowledge.

Emerging as the light
application

This is a rare and precious opportunity for you to up level in all areas of your life. The program is a 'game changer' and will teach you valuable skills that you can apply in service to your own upliftment and growth.

Get Updates And Stay Connected -Subscribe To Our Newsletter

Helping people find their way back to the fullness of their essential nature.

Emerging as the lightapplication

This is a rare and precious opportunity for you to up level in all areas of your life. The program is a 'game changer' and will teach you valuable skills that you can apply in service to your own upliftment and growth.

Get Updates And Stay Connected -Subscribe To Our Newsletter

Helping people find their way back to the fullness of their essential nature.

Emerging as the light
application