Which Group Session are you applying for?
Please ChooseSeptember 2024{"type":"select","name":"__generic","width":50,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"Please Choose\nSeptember 2024"}
How did you find the Women & ADHD group coaching program?
{"type":"radio","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please choose one of the above options.","options":"Women & ADHD podcast\nInstagram\nTikTok\nFacebook\nGoogle search\nFriend/Recommendation\nOther"}
Have you been diagnosed with ADHD?
{"type":"radio","name":"__generic2","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please choose one of the above options.","options":"I'm self-diagnosed\nI've been diagnosed by a professional\nI do not have ADHD"}
If officially diagnosed, how long ago were you diagnosed?
{"type":"text","name":"__generic3","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":"Approx date of diagnosis"}
Please share how a partial scholarship for the Women & ADHD group coaching program would impact your life.
{"type":"textarea","name":"__generic4","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
What are you able to pay?
{"type":"radio","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please choose one of the above options.","options":"I can pay $595 (in 3 installments)."}
Thank you for applying for a partial scholarship! We will respond to you shortly.
