Country *
Choose Your Country Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas (the) Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinational State of) Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory (the) Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands (the) Central African Republic (the) Chad Chile China Christmas Island Cocos (Keeling) Islands (the) Colombia Comoros (the) Congo (the Democratic Republic of the) Congo (the) Cook Islands (the) Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic (the) Denmark Djibouti Dominica Dominican Republic (the) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (the) [Malvinas] Faroe Islands (the) Fiji Finland France French Guiana French Polynesia French Southern Territories (the) Gabon Gambia (the) Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (the) Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Johnston Island Jordan Kazakhstan Kenya Kiribati Korea (the Democratic People's Republic of) Korea (the Republic of) Kuwait Kyrgyzstan Lao People's Democratic Republic (the) Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia (the former Yugoslav Republic of) Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands (the) Martinique Mauritania Mauritius Mayotte Mexico Micronesia (Federated States of) Midway Islands Moldova (the Republic of) Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands (the) New Caledonia New Zealand Nicaragua Niger (the) Nigeria Niue Norfolk Island Northern Mariana Islands (the) Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines (the) Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation (the) Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Southern Rhodesia Spain Sri Lanka Sudan (the) Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan (Province of China) Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands (the) Tuvalu Uganda Ukraine United Arab Emirates (the) United Kingdom United States United States Minor Outlying Islands (the) Upper Volta Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
Where did you hear about the Conscious Uncoupling Coach Training program? *
What is your current occupation and your professional background? If you have a particular specialty, please share it with us. *
If you have a website, please give us your URL, so we can learn more about you. *
Where have you enjoyed your greatest professional success in life? *
What qualities did you bring to your successful endeavors and how could you apply them to creating a successful Conscious Uncoupling coaching practice? *
Have you ever worked in a professional capacity as a therapist, counselor, coach, minister, etc.? If so, when, where and what credential, if any, do you currently hold? *
Have you participated in any of Katherine Woodward Thomas’s other courses or trainings and/or worked with her privately? If so, when and which one(s)? *
Please tell us about your desire to become a certified Conscious Uncoupling Coach and include why you believe you would make a good relationship coach. *
What has brought you the deepest sense of fulfillment and meaning in your life, and how might being a certified Conscious Uncoupling Coach expand your sense of fulfillment and meaning? *
List the 3 top reasons that you would like to become a Conscious Uncoupling Coach. *
On a scale of 1 - 5 (5 is highest), rate the following statements:
I feel CALLED to make a difference in the world: * m
I have a desire to HELP others: *
I have a desire for greater SUCCESS: *
I INVEST myself in my own personal development: *
I ENJOY being supported by others who are committed to my success: *
I am willing to APPLY MYSELF to be excellent: *
Are you ready and able to put in the time required for the training program? This includes weekly coursework for 9 months (about 3-10 hours per week, depending on which part of the program we’re in), weekly live calls and two 2-day digital retreats in September 2023 with Katherine. If your application is accepted, you will be able to review a training schedule before joining the program. *