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New U Virtual

Application Form

Let's start with your personal details

*

Age

What is your age?

A

18-23

*

B

24-32

C

33-40

D

41-50

E

51+

Address of your primary residential address (USA only)

*

Are you currently employed?

Are your currently employed?

A

Yes, Full-time

*

B

Yes, Part time

C

No

*

What are you looking to discover through NU?

*

What do you hope to gain from participating in this program?

*

Can you commit to attending 6 out of 6 sessions virtual sessions?

A

Yes, I can attend 6 sessions virtually

*

B

No, I can not attend 6 sessions virtually

How did you hear about us?

*

If you were referred by someone, please list who