Welcome!
The sign up process is expected to take 20 minutes to complete.

Sign up will be complete once you submit payment in the end. For tuition information, please refer to http://program.realizingempathy.com/faq/#how_much_is_the_program_tuition

Once you submit your payment, you will receive an enrollment verification within 24 hours. 

Enrollment is first come, first served with a limit of 20 total participants. In case your form is received after the limit has been reached, you will be put on the waitlist. If you do not wish to be put on the waitlist, you will have the option to cancel and receive a full refund.
Got it, Let's Begin!
 
Basic Information

Unless otherwise noted, we will not share your basic information with other people.
 
What is your first name? *

This information will be shared with your fellow participants.
 
What is your last name? *

This information will be shared with your fellow participants.
 
Would you like your fellow participants to call you {{answer_43944893}}? *

     
 
What would you like for them to call you then? *

This information will be shared with your fellow participants.
 
In case of emergency, at what phone number would you like to be reached? *

We will only call you if it is absolutely necessary. Please start with your country code.
 
What is the name of the organization you work for? *

If you're a freelancer who do not belong to an organization, please write "freelancer."
 
What is your title at the above organization? *

 
Demographic Survey

Your answers are optional. We will not share your demographic information with other people.
 
What is your gender?


 
What is your racial or ethnic identification?


 
What is your age group?


 
Tell Us About Your Past Challenges...

We will not share your answers to these questions with your fellow participants.
 
Tell us about a particularly challenging experience you had while trying to change yourself. *

Please describe what you tried, what worked well, and what struggles you faced.
 
Tell us about a particularly challenging experience you had while trying to change other people. *

Please describe what you tried, what worked well, and what struggles you faced.
 
Tell Us About Your Future Visions...

We will not share your answers to these questions with your fellow participants. Your answers will help us better understand your expectations.
 
Imagine this. It's 6 months after the completion of this program. You're very satisfied with the program. I happened to visit your city of residence. Out of sheer luck, I run into you during the visit. What changes you experienced since the program would you be most excited or proud to share with me? *

 
List 3 specific and concrete examples of the changes you described above. *

 
How do you imagine this program will help you realize the vision you described above? *

 
How may the training or advice you have received in the past help you realize your future visions?

Include books you've read or any relevant classes or workshops you have enrolled in the past.
 
Which program would you like to enroll? *

Basic Plus adds professional 1-on-1 coaching to the experience. If you're currently experiencing tension and conflict in your relationship, or feel deeply stuck, we highly recommend you enroll in the Basic Plus program.

For more information on the difference between basic and basic plus program, please refer to: http://program.realizingempathy.com/faq/#what_is_the_difference_between_basic_and_basic_plus_program

 
Please pick all times you could do for the Lecture + Seminar, Gym, and Reflection meetings. *

2 Workshops are scheduled to run on Saturdays while 7 other meetings (i.e. Lecture + Seminar, Gym, or Reflection) are scheduled to run on either Wednesdays or Thursdays during the following time slots.

A minimum of 4 students must be signed up for the same time slot to run. If we end up running our meetings only on time slots you cannot accommodate, you will have the option of getting a full refund or joining a different time slot.

For more information, please refer to: http://program.realizingempathy.com/faq/#what_is_the_schedule_like

 
Are there any last words you wish to leave behind?

 
Please submit payment *

The price of enrollment for the {{answer_43964885}} program is {{var_price}}.
 
Please enter your Credit or Debit Card number: *

 
The CVC number: *

(3 or 4 digit security number on the back of your card)
 
The name on your card: *

 
Your card's expiry month: *


 
Your card's expiry year: *


 
Please read the following refund policy carefully *

If you are waitlisted, you are not yet enrolled. If you cancel before enrollment, you will receive a full refund.

If you cancel within 12 hours of your enrollment, you will receive a full refund.

Once 12 hours have passed since your enrollment, the following rules apply to your refund:

If you cancel:

 - More than 3 weeks prior to the Monday of the first week of class, you will receive a 80% refund.

 - 1 – 3 weeks prior to the Monday of the first week of class, you will receive a 50% refund.

 - 1 – 6 days prior to the Monday of the first week of class, you will receive a 20% refund.

Cancellations made less than 1 day prior to the Monday of the first week of the program will not be eligible for a refund.

Your enrollment is transferable to another person. Thus, we suggest you find a substitute participant instead of forfeiting your refund.
     
Thank you! You will receive an email within 24 hours.
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