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Pelvic Health Kickstarter Academy: Diamond Edition Application Form

Please take a few minutes to fill out this short and sweet application!

The 1:1 mentoring component of this program means that spaces are limited. We only accept 10 - 15 students each season!

Make sure you are first in line for the next season of the Academy by getting your application in early! This program fills up FAST!

**Please note, this application does not guarantee you a spot in the Academy.**

Click the button below to begin our short + sweet application! 

Start

Question 1 of 11

Name

Question 2 of 11

Email

Question 3 of 11

Phone Number

Question 4 of 11

Why are you interested in learning more about Pelvic Health Physical Therapy?

Question 5 of 11

What is one of your biggest career aspirations/goals? 

Question 6 of 11

What has been the greatest obstacle holding you back from achieving your big career dream/goal?

Question 7 of 11

What is the most important thing in life/what drives you?

Question 8 of 11

The Pelvic Health Kickstarter Academy: Diamond Edition provides quality Pelvic Health Education, Resources, and Mentorship to help you explore one of the fastest growth fields in Physical Therapy!  What do you hope to achieve through your Academy experience?

Question 9 of 11

The Pelvic Health Kickstarter Academy: Diamond Edition costs $997. It is an investment in YOUR future and the future of our world! Is this within your budget? (**Please note: We never want finances to get in the way of you making the right decision for your future! Payment plans are absolutely available and we will do everything we can to make sure finances are not an obstacle!)

Question 10 of 11

On a scale of 1-10, how ready are you to join the Pelvic Health Kickstarter Academy: Diamond Edition and take a big first leap towards your dreams?! (1- I'm not ready; 10 - HECK YES! Let's do this!!)

Question 11 of 11

What aspect of the Academy are you MOST excited about?

(Select all that apply)
A

Pelvic Health Education!

B

Community!

C

1:1 Mentorship!

D

Networking Opportunities!

Confirm and Submit