Application Form - MENTI (#5)APPLICATION FORM - Peak Alignment: Mentally & Soulfully Grounded In Purpose & Power Please take your time filling out the questions below. They are intended to support you in getting clear on what you want to accomplish in this Experience and to let us see if what you want to accomplish is a match for the program. If this program is not a match, we will let you know and will refund your tuition. So, please be as authentic as possible so we can be sure this program is a match for what you want and need. Thank you. > Kay & The Peak Awakening TeamFirst NameLast NameEmailPhone/MobileFacebook Name/Handle (Note: Please also add ‘Kay Z Zakrzewski as a friend if you’re not already friends on Facebook)AddressAddress Line 1Address Line 2CityStateZip CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)RomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweBirth DayFULFILLMENT QUESTIONSThe following questions are specifically worded to evoke curiosity, wonder and intention with regards to your participation in Peak Alignment: Mentally & Soulfully Grounded In Purpose & Power. Please write down the answer that first comes to mind, no holds barred. Do not judge what you write; instead, let it flow through you. You might actually be surprised by what you say! This Experience will result in the fulfillment of what you write below.What’s something that’s felt out of reach that you deeply want to bring to life by participating in Peak Alignment: Mentally & Soulfully Grounded In Purpose & Power? Where or what do you see you most want to change?Why might you want to change (to have it be different than it currently is)? How ready are you to change (to have it be different than it currently is)? Where ‘1’ means ‘Not Ready’ and ‘10’ means ‘Totally Ready.’ Why didn’t you pick a lower number?Imagine you have changed, you've cleared your blockages and transcended your limits in this program, what would the positive outcomes be? Why are those outcomes important to you?What soul-aligned results or breakthroughs would make this program wildly successful for you? What do you want to feel more of in your life by the end of this program? GETTING TO KNOW YOU QUESTIONSWhat are you currently doing to support your mental, emotional, or spiritual well-being?What’s calling you to be mentally & soulfully grounded right now?When you’re facing a challenge, how do you typically respond or move through it? This program is fast-paced, growth-focused, and soul-aligned. What makes you feel ready for that right now?How do you see you will sabotage your success in this program? What will predictably take you out?What are you most proud of accomplishing in your life or career so far?Is there anything else you’d like to share to help me support you during this program?How’d you find out about us? If it was someone who told you, what’s their name so I can say thank you!ATTENDANCE QUESTIONSPlease record your attendance as best as you know it right now. If your attendance changes, we will tell you what to do about it in the first session. (NOTE: If you are doing the extra 30 minute pre-certification training at the end of each session, please do not indicate that on this form. We will deal with that at a later date).1. MISSING CLASS: Please check the box of the date of any session you know you will be missing. Tuesday March 17, 2026 Tuesday March 24, 2026 Tuesday March 31, 2026 Tuesday April 7, 2026 Tuesday April 28, 2026 Tuesday May 5, 2026 Tuesday May 12, 2026 I won't be missing any classes (and if anything changes, I'll let you know)2. LATE FOR CLASS: Please check the box of the date of any session you know you will be late. Tuesday March 17, 2026 Tuesday March 24, 2026 Tuesday March 31, 2026 Tuesday April 7, 2026 Tuesday April 28, 2026 Tuesday May 5, 2026 Tuesday May 12, 2026 I won't be late for any classes (and if anything changes, I'll let you know)3. LEAVING EARLY FROM CLASS: Please check the box of the date of any session you know you will be leaving early. Tuesday March 17, 2026 Tuesday March 24, 2026 Tuesday March 31, 2026 Tuesday April 7, 2026 Tuesday April 28, 2026 Tuesday May 5, 2026 Tuesday May 12, 2026 I won't be leaving early for any classes (and if anything changes, I'll let you know)LIABILITY WAIVER & CONFIDENTIALITY AGREEMENT FORMSAfter you submit this form, you will be redirected to a page where you can sign a Liability Waiver and Confidentiality Agreement. You are not considered approved for the program until these forms are signed. Thank you.Submit Form