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LifeCourse Institute of Adlerian Psychology
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LifeCourse Institute of Adlerian Psychology
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| LEAP on-line | Dr. Alfred Adler | Adlerian Concepts | Why take LEAP | Enroll in LEAP | Answers (FAQs) |
Email: bobhk@aol.com - Phone: 860-345-3204 Mail: LifeCourse Institute, 3 Mario Drive, Higganum CT 06441` |
| You can enroll in LEAP On-Line in just 3 easy steps: |
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Enroll in LEAP On-Line Today! |
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Call me at 860-345-3204 (after noon, Eastern Time). Give me your phone number and I will call you right back, so there's minimal phone charge to you. Note that you must be over 21 to take LEAP. NOT that LEAP is X-rated, but that the Patterns of personality aren't yet established until around that age. Exploring your Patterns before you are 21 isn't very useful, so please be at least 21 years old. Fill out the information below and have it handy when you call: Name ________________________________________________________ What do you want to be called? ____________________________ Mailing Address __________________________________ Home Phone: (____) – _____ - _______ Age: ________ yr. Time Zone: ________ Town/City ____________________________________________ State/Province _________ ZIP ____________ Sex: [_] Male [_] Female Cell: (______) – ______ - _________ email _____________________________ Web Site: WWW. _____________________________ [__] I wish to enroll in LEAP On-Line. I understand that . . .
Pay by (1) PayPal, (2) Bank/USPS Money Order, or (3) personal check. (Checks take up to 2 weeks to clear!) BELOW, check THREE times and days that will be best for you to meet for our sessions. (“1” for first choice, “2” for second choice, “3” for third choice.) Times are Eastern PM only. Not all times are available, of course. Others have already chosen some. Only those shown here are available. Complete the form below to have ready when you enroll.
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| Complete the following to include with your enrollment: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
What one problem would you like to be able to
"fix" by on-line counseling?
____________________________________________________________
What have you done about it so far? ___________________________________________________________________________________________
How well has that worked for you? ____________________________________________________________________________________________ What worked best? ________________________________________________________________________________________________________ What didn't work? ________________________________________________________________________________________________________ What do you get out of having this problem? What purpose do you think it serves for you to continue to have it? _______________________________
___________________________________________________________________________________________________________________ Your age? ________ yrs. Your sex: M F Are you married? Y N Ever divorced? Y N # Sons _________ # Daughters __________
Siblings:
# brothers ___________ # sisters __________
Your position: o first o second
o How did it feel as a child to be in your sibling position? ___________________________________________________________________________ What was the advantage for you of being your position among your siblings? __________________________________________________________ What was the DISadvantage for you? _________________________________________________________________________________________
Religion:
____________________
o
Education:
o
Politics:
o
Your work/career now: ____________________ Family attitude about work: _________________________________________________________
Family attitude toward YOUR work today: _____________________________________________________________________________________ The main problem you had as a child: _________________________________________________________________________________________
How you plan to solve the problem you had as a kid: _____________________________________________________________________________
When do you plan to have your childhood's problem solved? ______________________________________________________________________ Your main goal in life: _____________________________________________________________________________________________________
Write
a sentence or two to describe a problem, question, or decision you face in your life
right
now/these days. This may become the "Practice Task" to
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How to pay by PayPal |
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We accept Credit Card payment through PayPal. We also accept a bank or US Post Office money order, or a personal check. If you haven't used PayPal before, here are the steps. It will take you only a couple of minutes to set it up. 1. To sign up if you're not a PayPal member you'll need to give your email address and create a PayPal Password. You'll also need to give name and address. 2. You then log in to Your Account. ("your transactions" is a record of your PayPal dealings. You can look at it later.)
3. Log into My Account. This gets
you to the Send Money screen with 3 things to do: NOTE: You can use PayPal to order books, too: Type in bobhk@aol.com, type in the amount, click on Services/other, click Continue & follow any other instructions. |
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Email: bobhk@aol.com - Phone: 860-345-3204 Mail: LifeCourse Institute, 3 Mario Drive, Higganum CT 06441`[rev. 1-20-2010] |
