Application Form

Complete our form to apply to join the SHB program. Be coached to a life of freedom and no holding back!

ABOUT YOU
arrow&v
arrow&v
MORE ABOUT YOU
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
LIFE AT WORK
*If you are currently unemployed please skip this section of the form.
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
LIFESTYLE
arrow&v
arrow&v
ABOUT YOUR STUTTERING
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
I generally stutter when I…
Which of the following speaking behaviors do you often feel you do?
TRUE OR FALSE TEST

Directions:

Choose TRUE for each statement that is true or mostly true for you and choose FALSE for each statement which is false or not usually true for you.

arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v