Applying for this program is quick and easy, with no commitment needed.
Just fill in the brief questionnaire below.
All application information is kept strictly confidential.
Who is the program for?
If other please specify your relationship with them:
If applying for another person, simply complete the form as they would.
If other please state their name:
State & Post Code
e.g. Student, building apprentice, none etc...
How would you rate your self-esteem?
7 - 8 Pretty Good
5 - 6 Average
3 - 4 Not Good
1 - 2 Bad
i.e. how much you like yourself, and who you are.
List current health issues
What one thing you would like to get from this program: