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For Such A Time As This Intake Form

FOR SUCH A TIME AS THIS is a four-week private coaching intensive for those who know, somewhere deep down, that the life they’ve been living no longer fully aligns with who they’re becoming, and are ready to discern what needs to be released, realign with what matters most, and step more fully into their higher calling.

This application is an opportunity for me to learn a little more about you, the season you’re in, and what is calling you toward this work. These questions are designed to help both of us get clear. There are no right or wrong answers, only your truth. If something feels too tender to write out, you can skip it or simply note that you’d prefer to talk it through. And if you have any questions at any point in this process, please don’t hesitate to reach out. I’m here. Take your time. Be honest. And know that this is already part of the work, showing up and being willing to look at what’s true.

Personal Information

Full Name:

Email Address:

Phone Number:

Location:

Your Current Season

What brings you to this work right now? Describe what’s happening in your life that led you here. What are you navigating, feeling, or experiencing?

Are you currently in a major life transition?

Yes

Unsure

If yes, please describe:

Which of the following resonates most with where you are right now? (Check all that apply)

On a scale of 1-10, how ready are you to do deep, emotionally honest work? 1 (Not ready) — 10 (Fully ready). Please explain your answer below.

What are you hoping will shift or change through this work?

Inner World

What patterns do you notice repeating in your life? This could be in relationships, work, how you treat yourself, or how you respond to stress.

What are you carrying that you know isn’t yours to hold? Think about burdens, expectations, messages, or weight passed down from family, past relationships, or societal pressure.

What does “shedding” mean to you right now? What needs to be released?

How do you currently make space for stillness, reflection, or prayer in your life?

What does your relationship with control look like? Are you someone who needs to plan everything? Do you struggle to let go? How comfortable are you with uncertainty?

Your Support System

Who holds safe space for you right now? Who can you talk to honestly without judgment?

Who in your life drains your energy or undermines your peace?

Are you currently in therapy or working with another coach/counselor? ☐

Yes

If Yes, please explain below:

Have you done trauma work before?

Yes

If Yes, please explain below:

Your Readiness

This work requires meaningful commitment and depth. What does commitment look like for you right now?

What might get in the way of you showing up fully for this work? Be honest—time, finances, fear, resistance, other obligations, etc.

What scares you most about this work?

What excites you most about this work?

Are you willing to:

Complete weekly assignments between sessions

Engage in spiritual practices (prayer, reflection, stillness)

Be emotionally honest, even when it’s uncomfortable

Challenge patterns and beliefs that no longer serve you

Trust the process, even when it feels uncertain

Your Story

Describe your family of origin in a few sentences. What was your household like growing up? What roles did you play?

What messages did you inherit from your family about love, success, failure, or emotions?

What does your relationship with faith, spirituality, or a higher power look like?

Have you experienced significant trauma or loss?

Yes

You don't need to share more details here, just knowing helps me hold space. But if you would like to share more, please do so below

The options below reflect different areas of life, inner experience, and discernment that often surface during seasons of transition and deep work. Please check all that resonate — there’s no need to narrow or prioritize yet. This is simply a way for me to see where you’re feeling drawn to go deeper and what you’re hoping to receive from this time

Higher Calling

What do you feel you may be being called toward—even if you can't fully articulate it yet?

Have you been given a clear vision in your life as to what your Higher Calling is while on this Earth? Perhaps a word from God, something spoken over you by a loved one or a mentor, that may be calling you towards something greater?

Investment & Logistics

The investment for this 4-week container is $3,100.
Transparently, I prayed long and hard about how to price this as I put a lot of time into each human way beyond the scheduled calls. As a woman always desiring to be seen and to serve as a PRO 31 woman, I landed on $3,100, although my other programs are typically priced higher. If you feel in your heart we are supposed to work together and the investment is not reachable, let's discuss your situation before you walk away.

What is your preferred start date or timeframe for beginning this work?

Are there any scheduling considerations I should know about? (Travel, work commitments, etc.)

Final Reflection

In one word or one sentence, what do you hope to become through this work?

Why do you believe this is the next right step for you?

By submitting this form, I acknowledge that:
-All sessions will be held via Zoom
-I am committed to showing up honestly and fully if accepted
-I understand this is trauma-informed, spiritually grounded work that requires courage and vulnerability
-This work is selective, and acceptance is based on readiness and fit -If accepted, the full investment is required regardless of completion, as this is a mutual commitment

Signature

*By signing, you are not held to any financial obligation at this time.

Date Signed:

Thank you for your honesty and courage in completing this intake. I will review your responses thoughtfully and be in touch. -Caitlin