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28 Day Intensive Screening

Welcome — and thank you for your interest in joining the SOMAE 28-Day Intensive: Coming Home to Ourselves.

This brief questionnaire helps us ensure the program is a good fit and that you’ll feel supported, safe, and ready to fully engage in this work. A few things about us: SOMAE is a welcoming environment inclusive of all people of gender identity, age, race, orientation, religion, ability. We welcome all identities and we create a safe and respectful space where you are welcome as you are.  

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Question 1 of 20

We are thrilled you are answering to this calling! Please share your motivation for wanting to take this course. Feel free to share how you found us.

Question 2 of 20

This program involves daily live virtual practice (evenings) and four 90-minute Saturday deep-dive sessions. There will be replays available. Are you able to attend live sessions with your video on whenever possible? 

A

Yes, I can commit to this.

B

I may need to view some recordings.

C

No, I prefer to participate off-camera.

Question 3 of 20

Do you have reliable internet access and a quiet space for participation? 

A

Yes

B

Sometimes

C

Not consistently

Question 4 of 20

What draws you to this 28-day nervous system regulation intensive?

Question 5 of 20

What do you hope to gain or change through participating in this program?

Question 6 of 20

Have you previously engaged in therapy, coaching, or somatic work related to regulation, trauma, or mindfulness? If yes, please share briefly:

Question 7 of 20

Are there any current stressors, transitions, or life situations that may make daily participation difficult (e.g., major work stress, caregiving, instability, acute grief, etc.)?

Question 8 of 20

Do you currently feel emotionally and physically safe in your home environment?

A

Yes

B

Mostly

C

Not consistently

Question 9 of 20

Do you have a calm and private space where you can participate and practice each day?

A

Yes

B

Sometimes

C

No

Question 10 of 20

This program is not a substitute for therapy and is not appropriate for individuals in acute crisis or active suicidality. 988 is the Crisis Line available 24/7 and if at anytime you are not feeling safe, this is a good number to have in your phone for support. Have you had any suicidal thoughts in the last 90 days? 

A

Yes, I had thoughts but not a plan

B

No, I have not had any thoughts about taking my own life.

C

Yes, I had thoughts with a plan on how I might end my life.

Question 11 of 20

Are you currently working with a therapist, psychiatrist, or other mental health provider? If so, please describe the supports you currently have in place. 

Question 12 of 20

What helps you feel most grounded or safe when you’re overwhelmed or stressed?

Question 13 of 20

How do you imagine daily nervous system practice could support your healing or growth right now?

Question 14 of 20

How would you like to feel at the end of this course? 

Question 15 of 20

Is there anything you would like to share about yourself that would help us make your learning experience optimal?

Question 16 of 20

How would you describe your current experience with regulating your nervous system - your ability to return to a sense of calm, safety, or balance after stress? Please choose the statement that feels most true for you right now:

A

šŸŒ± I rarely feel regulated. I often feel stuck in stress, shutdown, or overwhelm and have difficulty finding calm.

B

šŸŒ¤ļø I can sometimes regulate. I have moments of calm, but it feels inconsistent or short-lived.

C

šŸŒ¾ Iā€™m learning to regulate more often. I can notice my states and use some tools that help me return to balance.

D

šŸŒ· I feel mostly regulated. I recover from stress more easily and feel connected and present most of the time.

E

šŸŒž I feel deeply regulated and resilient. I can meet challenges with awareness, flexibility, and a steady sense of safety in my body.

Question 17 of 20

I understand this program is educational and coaching-based, not psychotherapy or medical treatment.

A

I understand and agree.

Question 18 of 20

I agree to practice self-responsibility and self-awareness throughout this program, and to reach out for professional support if I become emotionally distressed.

A

I agree.

Question 19 of 20

I’m ready to engage in a month of consistent practice, reflection, and gentle personal growth.

A

Yes, I'm ready!

B

I'm ready, but anxious.

C

I'm not sure yet.

Question 20 of 20

Thank you for taking the time to reflect.

The SOMAE 28-Day Intensive is designed to help you reconnect with safety, presence, and balance — at a pace that honors your unique nervous system.Once reviewed, we’ll contact you with next steps and enrollment confirmation.  

 

Please add your full name, email address and phone number to the space below. Please ensure you include this information so that there are no delays in processing your application. 

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