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Screening Survey for the LOVE NOW Method Love-Conscious Leadership Program

Complete this quick screening to move onto your clarity call.

Click the button below to start.

Start

Question 1 of 9

Please enter your name.

Question 2 of 9

Please enter your email address.

Question 3 of 9

Are you a Vermont resident?

Question 4 of 9

Have you been a Vermont resident for at least one year?

A

Yes

B

No

Question 5 of 9

How many people are currently living in your household?

Question 6 of 9

Are you...

A

Employed?

B

Underemployed?

C

Unemployed?

Question 7 of 9

If you're employed, what's your current occupation?

Question 8 of 9

In what areas of your life do you need help with right now?

Question 9 of 9

To help us determine whether or not you'll qualify for our grant and scholarship program, please tell us your annual household income.

Confirm and Submit