Take time to provide as much information as you can on your application. There is plenty of room to write your responses to the application questions. You can save your work at any point and come back later to finish it.   We want to make sure that you quality and will fit into this social anxiety group treatment therapy, so that you can be on the path to overcoming social anxiety for good.   

This application form is for both the international therapy group and the local therapy group.  Please indicate which group you're applying for in the text you submit.


At the time of application, you must be through session four (4) of the audio/video series. Please do not fill out this application unless you are working in session four or beyond.
Please type correctly and check your address. This is the only manner in which we can respond to your application.
No P.O boxes