The Rewrite Circle Application

Name *

First Name

Last Name

This space requires emotional honesty, creative vulnerability, and embodied action. Are you ready for that kind of devotion?

Yes, I’m fully in.

I want to be, but I have some fear.

I’m unsure and exploring.

Have you worked with a private mentor or coach before?

Briefly explain if you'd like...

Yes

No

Are you available for 6 consecutive weeks of live 90-minute sessions?

Yes

No

I can make adjustments if needed

This experience is $5,000 USD. How do you plan to pay if accepted?

In full

I need a payment plan

I’m not currently in a position to invest

If accepted, are you willing to show up fully — for yourself, the circle, and your creative emergence?

Yes, I’m ready.

I’m still feeling it out.