Private Work Application Prep Form Name* First Last Date* Email* Please complete the following prep assignment questions. Once completed, submit them by taking pictures of your completed worksheets and sending them directly to Jessica at jessica@EscapeFromEmotionalEating.com more than 24 hours prior to your Discovery Session. Thank you! 1). What was your biggest takeaway from the Winter 2019 ESCAPE?*2). How will this impact you over the next 6 months? Give 2 specific examples.*3). What is the next thing you’d like to see change in your relationship with food, body and inner peace?*4). What specifically has you interested in private support?*5). How do you specifically sense private support will support you over the next 6-18 months? (List at least 3 bullet points)*6). What new insights did you receive from our work together at the ESCAPE specifically around how you put yourself in jail within your own life?*7). The Escape From Emotional Eating Private Programs require a high level of personal responsibility, a high level personal commitment and a willingness to do whatever it takes to create the peace and health you so desire. They also require a higher level in the investment of time, energy and resources. Is this in line with the level of support you are ready to receive and the investment you are ready to make? (select which option is most true for you)* Yes. If I feel called to this level of support. When I want something, I'm willing to make it happen. Maybe. I don't have much faith in my ability to succeed because I've tried so many times and failed. I'm scared to be fully committed, especially financially, because I'll just fail again. Maybe. I am interested in learning more & need to know pricing to see if it's even something I can even begin to afford because there are limitations. No. I'm looking for only one-on-one sessions and just need a few to set me straight. Other (explain below) Other:8). In making the decision to invest in support around this, are you the sole decision maker? Or would someone else be involved in the investment decision? If so, who would that person be?*9). What else is important for me to know when considering you for a spot in the Escape From Emotional Eating Private Program of your choice?* Once completed, submit your completed worksheets by taking pictures of them and emailing them directly to Jessica at jessica@EscapeFromEmotionalEating.com more than 24 hours prior to your Discovery Session. Thank you!