Extreme Emotional Makeover: Contest Application

Name:

City, State:

Daytime Phone:

E-mail address:

Gender: Female
  Male

Military experience? Yes
  No

Where did you here about us?

Have you ever had any coaching, counseling, or therapy? Yes
  No

If yes, what were the results? How could you have made the results better?

If no, What are your views of the effectiveness of coaching, counseling or therapy?

Are you a giver or a taker? Please explain.

Do you have good friends? Yes No

How do you support each other emotionally?

Who is your biggest role model/hero? Why?

Who is your biggest enemy/person you hate? Why?

List the 5 most important things in your life:
1.
2.
3.
4.
5.

What are you passionate about?

List three strengths:
1.
2.
3.

List three weaknesses:
1.
2.
3.

List three regrets:
1.
2.
3.

What are you proudest of?
1.
2.
3.

What are you the most ashamed of?

When was the last time you cried?

When was the last time you were screaming angry?

Who or what are you angry at?

What do you do with your anger?

Who or what hurt you the most?

Do you believe your past is affecting you today? Yes
  No

If so, how?

What are some of your biggest issues?

How private a person are you?

Do you have secrets that you don’t tell anyone?

How important is it for you to be liked?

How important is it for you to be respected?

How important is it for you to be included?

For the following questions, rate yourself on a scale of 1 to 10 (1 is lowest):

What is your overall emotional quotient (EQ) level?

How would you rate your love relationships?

How would you rate your motivation to grow/change?

When you were growing up, what was the EQ of your caretakers?