Name *

First Name

Last Name

What is your racial/ethnic background?

(Optional)

Asian

Black (African/Caribean)

Hispanic/Latinx

Indigenous

White

Other

Prefer not to say

If yes, please specify your type(s) of disability:

(Select all that apply)

Neurodivergent

Physical Disability

Mental Health Condition

Sensory Impairment

Other

Prefer not to say

Have you worked with a coach or attended a coaching workshop before? *

Yes

No

What brings you to this workshop? *

(Select all that apply)

Seeking clarity and direction

Overcoming self-doubt and fear

Turning challenges into confidence

Building resilience and inner strength

Taking action toward personal or professional goals

Finding a supportive community of like minded women

Would you like to receive more information about my SheRISE Group Coaching Program? *

Yes, I’d love to explore how I can continue this journey.

No, I’m just here for the workshop.