Getting to Know You as a Coach Before the Intensive

Welcome! I’m so looking forward to having you join me as a Coach at my Bravery After Betrayal: It Takes Fierce Strength Intensive. You’ve joined a special and amazing group of women. Since you’re new to our team, we’d like to get to know you a little better. As you know we have small groups at the intensive and our attendee’s fill out an extensive questionnaire about themselves that both Karene and I lovingly & prayerfully read. We mainly use it to determine which group and which coach will be the best fit for them. In order to do our very best to care for them, getting to know your story is vital. This questionnaire will take about 15-20 minutes to fill out and must be done in one sitting. Please kindly fill it out and hit send. It’ll give me some direction on what ladies to put in your small group at the intensive.

Warmly,
Sheri

Name*
First Last
Email (Please use the one you have regularly corresponded with to us)*
Select one of the below.*
- I have a US Phone Number
- I have an International Phone Number
US Phone Number*
International Phone Number*
What are the dates of your intensive?*
Emergency Contact Name*
First Last
Select one of the below.*
- They have a US Phone Number
- They have an International Phone Number
Emergency Contact US Phone Number*
Emergency Contact International Phone Number*
1. How Did you First Hear About the Bravery After Betrayal Intensive?*
- Email
- Friend
- Radio
- Podcast
- Facebook
- Instagram
- Twitter
- YouTube
- Counselor
- BraveOne Website
- Spouse/Significant Other
- Event
- Other
What event?*
Other*
2. What have you heard about the intensive, if anything, before we contacted you?*
3. Have you attended a Bravery After Betrayal intensive before as an attendee?*
- Yes
- No
If yes, when?*
4. Are you currently a BraveOne Community Member?*
- Yes
- No
Have you ever been a BraveOne Community Member in the past?*
- Yes
- No
5. Do you know anyone in my BraveOne Community?*
- Yes
- No
6. Please list all your training, licensing, certifications and credentials, including where you received them from. Please take care to include all that apply to sexual compulsivity/addiction and sexual betrayal trauma. Do not use acronyms. Please spell it all out. For example: Do not put CPC, instead put Certified Partner Coach through APSATS.*
7. What's your relationship status? Check ALL that apply.*
- Engaged
- Married
- Widowed
- Living Together
- Separated
- In-House Separation
- Therapeutic Separation (Have or are working with a therapist on a Therapeutic Separation document)
- Legal Separation
- Going Through Divorce
- Divorced
- Divorced and Remarried
- Single
8. How long have you been married or in the relationship? If you are divorced, how long were you in the relationship where the sexual betrayal occurred and how long have you been divorced?*
9. What is your age range?*
10. Do you have children?*
- Yes
- No
If yes, how old are they?*
11. What City are you in?*
12. What State and/or Country are you in?*
13. Do you agree to arrive on the Intensive premises no later than 2:30pm local time on Thursday, October 23, 2025, and leave the Intensive premises no earlier than 2:45pm local time on Sunday, October 26, 2025?*
- Yes
- No
14. Are you driving a vehicle to Angeline each day that will need parking?*
- Yes
- No
We're looking for a few ladies who'd be willing to drive a short distance for a field trip during the intensive on Saturday, October 25th. Is that something you might consider? If yes, would you please plan on driving your car to Angeline on Saturday, October 25th?*
- Yes
- No
How many can you take in your car including you?*
15. Do you have any food sensitivities/allergies?*
- Yes
- No
If yes, please list them here. Please note if you have a life threatening allergy or an allergy that has resulted in a visit to the emergency room.*
16. Will you need wheelchair access?*
- Yes
- No
Would you mind sharing a little bit more about your needs? The more details, the better we can serve you while at the intensive.*
17. Are you allergic to bees?*
- Yes
- No
Do you have an EpiPen you can bring?*
18. Have you had the opportunity to read my book Intimate Deception: Healing the Wounds of Sexual Betrayal? If you haven't would you please read or listen to it before the Intensive?*
- Yes, I have already read it
- I haven't but I'd be happy to read it
- No
19. How would you describe your spiritual life? Do you have a particular faith orientation?*
20. Excluding the BraveOne Community, are you currently in or have you regularly attended a betrayal trauma support group?*
- Yes
- No
If yes is it:*
- Face to Face
- Over the Phone
- Zoom/Skype
What's the name of the group/organization?*
21. Are you currently seeing a coach, counselor or therapist?*
- Yes
- No
- Not currently, but I have in the past
Are they CSAT, CPTT or APSAT certified?*
- Yes
- No
Were they CSAT, CPTT or APSAT certified?*
- Yes
- No
22. Do you know someone else who's attending the intensive on the same weekend?*
- Yes
- No
If so, please type in their name(s) here and in the last name section, write the last name and then put a space and indicate if they are a coach/staff or an attendee.
First Last
First Last
First Last
First Last
First Last
23. While I can't make any promises, indicate below if you'd like us to try and put any attendee's you listed above in your small group or if you think it would be better for them to be in a different group.*
- Yes, I'd like you to try and put them in my small group.
- No, I feel it would be best for them to be in a different group. (Your answer will remain confidential.)
- I have no preference. I'm good either way.
- I didn't list anyone.
24. How long have you been aware of your current/former spouse/significant other's sexual acting out?*
25. What types of sexual acting out are you aware of? Check all that apply.*
- Pornography
- Masturbation
- Topless Bars
- Massage Parlors
- Watching Someone in Their Home or Apartment
- Strip Clubs
- Hookup with Random Person for Sexual Encounter
- Affair - With Someone They Know
- Affair - Emotional Affair
- Affair - Multiple Partners
- Affair - With a Coworker
- Affair - That Resulted in a Pregnancy
- Illegal Sexual Activity
- Sexual Fetishes
- Sexual Encounter with Same Sex
- Cross-Dressing
- Prostitutes
- Bestiality
- Sexting
- Cyber-Sex
26. Is your current/former spouse/significant other acting out currently?*
- Yes
- No
- Not Sure
27. In a few sentences, what three areas are you particularly passionate about as a coach when it comes to sexual betrayal?*
28. Does/Did your significant other engage in any of the following depictions of violence on an ongoing basis? Please check all that apply.*
- Physical Abuse
- Violence (breaking things, throwing things)
- Threats of Physical Abuse or Violence
- Cruelty to Animals
- None of the Above
29. Have you ever had to go to a domestic violence shelter or leave your home because of violence?*
- Yes
- No
30. What type of care have you received for your betrayal trauma? Check all that apply.*
- Counseling
- Coaching
- Face to Face Recovery Group
- Phone Recovery Group
- Online Recovery Group
- Faith Based Help
- Retreat
- Workshop
- Intensive
- Inpatient
- None
- Other
Other:*
31. Has the one who betrayed you received any kind of intervention, treatment, or care? If so, what type? Check all that apply.*
- Counseling
- Coaching
- Face to Face Recovery Group
- SA/SAA Recovery Group
- Celebrate Recovery
- Phone Recovery Group
- Online Recovery Group
- Faith Based Help
- Retreat
- Workshop
- Intensive
- Inpatient
- None
- Other
Other:*
32. Are you the current/former spouse of a current or former clergy/pastor/priest/rabbi/missionary/serving in ministry that has/is acting out?*
- Yes
- No
33. Many of our Coaches give a 5-7 minute testimony at the Intensive. Are you willing to give yours?*
- Yes
- No
What is keeping you from doing so?*
Name an area or two you might want to vulnerably focus on in your testimony.*
34. Time to brag on yourself! What areas do you feel you're especially strong in as a coach? Please be specific and elaborate.*
35. In a few sentences, what are some things that partners often resonate with about your story?*
36. Share some important things I should know about your story that will be helpful to me when putting ladies in your small group?*
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