Join Her Rebuild Collective

Complete the application below to be considered for our founding 8-week Her Rebuild Circle. This peer-support and personal-growth experience is designed for women ready ro reflect, rebuild, and move forward with intention.

Full name

Email address

Phone number

Age range

Preferred session type

In-Person

Virtual

Either

What brings you to Her Rebuild Collective?

What are you hoping to gain from the group?

General availability (days/times)

Emergency contact (optional): name, relationship, phone

I understand that Her Rebuild Collective is a peer-support and personal-growth community. It is not therapy, medical care, crisis intervention, or emergency mental-health treatment.

What made you interested in joining Her Rebuild Circle?

What are you hoping to gain from this experience?

Are there any topics you may find especially difficult or emotionally triggering to discuss? You do not need to provide details you are uncomfortable sharing.

What area of your life do you feel most ready to rebuild right now?

Are you comfortable participating in a group where other women may share emotional or difficult experiences?

Yes

No

Unsure

Are you reasonably able to commit to attending an 8-week program, with one session per week lasting approximately 75-90 minutes?

Yes

No

Unsure

Which meeting format would you prefer?

Virtual

In person

Either

Which time generally works best for you?

Morning

Afternoon

Evening

Complete this sentence: Right now, the woman I am becoming is learning to ______________________________.

I understand that submitting this form does not guarantee placement in the founding Her Rebuild Circle. I understand the purpose of the group and agree to participate respectfully if selected.

I agree

HER REBUILD COLLECTIVE

Join the founding her rebuild circle

Join Her Rebuild Collective