Intent Form for Ecology of Awakening Vision Fast

Thank you for your interest in the Vision Fast! Please complete the following form in order to help us determine whether this program is a fit for you. We will keep all information strictly confidential. Please note that you cannot save this application. Be prepared to complete this form in its entirety before submission. (Feel free to compose your responses separately and cut and paste into this form when you are ready.)

Name

First Name

Last Name

Email Address

Phone

Country

(###)

###

####

Address

City and State/Country

Date of Birth

YYYY

Gender

Occupation

Please describe, in one to two pages, why you are called to participate in the vision fast. You might include any significant life transitions you are in the midst of, where you are in your ‘awakening process’ and/or what you sense as the greatest possibility for how the program might support you in your journey

Have you participated in previous nature-based, soul-based and/or awakening-focused programs in the past? If yes, please list.

Please respond with a maximum of 500 words.

People often confront emotional edges as a part of the unwinding of their personal and cultural conditioning. Please describe what you know about how you navigate your own edges and if there’s anything that would be helpful for us to know as your guides

Please respond with a maximum of 500 words.

Are you presently undergoing treatment or taking any medications for emotional/psychological issues and/or working with current or past addictions?

Please respond with a maximum of 500 words.

Anything else?