Workshop Application

Anochi Workshops

Please fill out this form to complete your registration.

This form has also been emailed to you.

Name (legal and what you are called)

Date of Birth

Address

Occupation

In 3-5 sentences, please tell us your motivation for attending Anochi. To maximize your experience with Anochi, please provide as much detail as possible on your motivation for attending. What do you feel you would get out of this experience? What is not working in your life that you are hoping will change? What made you decide this was the right time for you to attend our workshop?

In 2-5 sentences, tell us a little bit about you, how you see yourself, and where you’re headed in life:

Where do you hope to be in five years? Where are you afraid you might be in five years?

What hobbies and activities bring you joy and how often do you engage on those?

What are your three top qualities? Feel free to celebrate yourself and brag a bit!

What are you currently most drawn to? This could be a song or something similar to it that has some sort of relativity to the current state of your life.

What are the three things about yourself that you most need/want to work on or wish you can change?

If you could go back in time and change one decision you made, what would you do differently and why?

Do you have a trusted mentor or guide that you reach out to for advice or guidance when needed? If so, please tell us more about this person and your relationship to them. If you do not have such a person, what is preventing you from having someone like this in your life?

Parents. Tell us about your parents. Were you raised in a two parent home? The product of divorce? Step-parents? Adopted? What is the relationship between your parents? What relationship do you have with each of them?

Siblings. Kindly list down the name of your sibling and provide a brief description of your relationship with them.

Home: How would you describe the home environment you lived in as a child?

If you are married or committed to a relationship, kindly describe the nature of your relationship with your significant other. If not, please tell us if you choose to stay uncommitted and your reason for the choice.

If you are a parent of children, please list their names, ages, and a SENTENCE about your RELATIONSHIP WITH EACH.

Have you previously attended an Anochi Workshop or event? Or have you ever participated in a self-help or self-development workshop, coaching session, or therapy? If so, How long did you commit yourself to it? Was it helpful or not?

Have you ever experienced any form of abuse or other types of trauma, such as death, illness, or accidents, that have had a significant impact on you? If comfortable, please describe any overt signs of trauma you experience, such as panic attacks or dissociation. This information is relevant for us to better understand your situation..

Have you ever been diagnosed with any mental health condition such as ADHD, bipolar, schizophrenia, clinical depression, eating disorders, etc? If applicable, please let us know if you have a current treatment plan we should be aware of.

Do you use alcohol, drugs, food, sex or any other substance/activity compulsively or in an addictive manner? Or do you currently or have you ever engaged in recreational drugs? If the answer is yes, what kind and how often?

Do you have a history of suicide attempts or making suicide plans or have you had any serious thoughts on suicide?

Do you consider yourself religious? Feel free to elaborate on your level of religious observance (i.e. describe your relationship to prayer and how you view your relationship to God/Hashem/Spirit or higher power.)

If this workshop were able to give you everything you hoped for, how would you personally apply change into your life and relationships?

What do you think limits you or stands in the way of you achieving the above? Share with us your hesitations and fears that you feel we should know.

Yes, I’d love to receive inspiring updates, exclusive offers, and transformational content via email and SMS. No spam, just meaningful messages

Anochi Workshops

Please fill out this form to complete your registration.

This form has also been emailed to you.

DOWNLOAD THE FREE GUIDE