Jen Mac's Something Different for Women

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One Time Request Form

Welcome! We’re so happy you’re here! This is our uniform, 1 time form to ensure this work & community are a right fit for you at this point in time. Please answer the following brief questions as well as read through & check off our community’s policies, privileges & disclaimer. Please note: this form's designed to be filled out in one sitting, so as to avoid the process being timed out & having to start again, please be sure to start this when you have at least 15-20 consecutive minutes free. Thank you!

Jen Mac’s group & 1 on 1 programs provide excellent, secondary support to all enrolled! This means there’s support during each actual class or session via Jen's teachings, her in class or in session exercises, her homework assignments & the community you’re able to connect with here! Because we’re a community of hundreds though, it’s not physically possible for Jen to give additional private time outside of classes or sessions. Therefore, we require all participants have a primary support system already in place so you're always fully supported! This means you have any or all of the following: supportive parents(s), supportive sibling(s), supportive spouse or partner, supportive friend(s), supportive colleague(s), supportive therapist, support group, supportive clergyman/woman, supportive spiritual/religious community of some kind.

Yes, I have a primary support system in place and would like to continue.

Full Legal Name (required)

Email Address (required)

Mobile Phone (required)

Please provide either Home or Work as a second contact number:

Home Phone

Work Phone

Country (required)

State (required)

Province/Region (required)

City (required)

1. I am: a leader an aspiring leader

Please check all that apply:

for my own company

for a company/organization

for a team/staff of people

for my immediate family

for my extended family

for my household

for my partner

for my child/children

for an additional organization I run and/or sit on the board for

for an additional organization I volunteer for

for my community

for other*

Please check all that apply:

for a business I’m starting/would like to start

for a position I’d like to move up or into at work that includes leadership responsibilities

for myself; to be better to myself in all areas of my life

for my immediate family

for my extended family

for a child I plan to have soon

for a child I plan to have someday soon

for an organization I volunteer for

for my community

for other*

2. At this juncture of your life, what specifically are you looking to either improve, positively change or create next for yourself, personally and/or professionally? How are you hoping our program will support you with this? Please explain.

0/1000

3. What are 3 adjectives you would use to describe yourself?

What are 3 adjectives someone who knows you really well would use to describe you?

What are 3 adjectives you think someone who just met you would use to describe you?

4. The following leadership qualities identify me (please check all that apply):

kind

positive

hard working

solution oriented

helpful

humble

efficient

friendly

approachable

studious

focused

responsible

reliable

persistent

result-oriented

other*

5. Please share 1-3 of your greatest accomplishments to date...& why you feel they’re your greatest accomplishments so far.

0/1200

6. Which best describes you? a. I’d positively contribute to any group & while my life’s presently great, I can always learn more to further develop myself...so sign me up please! b. I’d positively contribute to any group & while my life’s presently good, there are definitely areas that can use improvement...so sign me up please! c. My life’s presently not so great yet I know developing myself further will benefit me & that I’d still be a positive contributor to any group...so sign me up please! d. My life’s presently not so great yet I need something still I’m not sure I’d positively contribute to a group right now so signing up another time’s probably best.

7. Who personally referred you to us? If you were not personally referred, how did you hear about us?

Community Policies & Privileges

*Please Check Off Each Box After Reading

I understand that participation in Jen Mac’s Something Different For Women classes, programs and/or tele-programs requires a deep personal desire, openness & receptivity in order to gain the full benefits of what is offered & therefore, no gifting or transfers of classes, programs or tele-programs are allowed. (If you’re interested in understanding more, please read about it further on our FAQ page).

I understand that every class is set up to benefit me as much as possible on every level & therefore, may include any or all of the following; solo weekly or monthly homework assignments, partnered assignments, partner check-ins via text, email or phone, small group sharing, interactive class exercises & Q&A time. I also understand this is both an interactive & supportive community where my own personal success is enhanced by my participation & by allowing myself the available support within it! Therefore, some programs also offer the added support of a private Facebook group for additional connection & support in between classes (if so desired) for the duration of the program. In addition to the time I spend attending the actual class(es) or tele-classes, there is also a much encouraged (though again, not required) additional time commitment of 1-5 hours per week to implement class assignments. This is suggested so I can not only learn how to make positive changes but also live them! While I understand nothing is mandatory, I also understand that what I put into the class/program/tele-program is what I will get out of it & therefore, am encouraged to participate in all or as much as possible for me, so that I may garner the results I desire.

I understand that for all classes, programs & tele-programs, payments are only made in full, via e-check, debit or credit card via Paypal, in advance; prior to the start date of every class, program or tele-program & that all payments are non-refundable.

I understand that if I am signed up for a class, program or tele-program & have to miss a class for any reason, I have the opportunity to make it up by watching the recorded live stream (if it’s a live class) within 30 days of the actual class or by listening to the recorded call (if it’s a tele-class) within 30 days of the actual call. I understand that this is my sole option for making up a class & that if I need to utilize it, it is my responsibility to implement the following protocol; email clientcare@jen-mac.com before or by the class date so that I may gain access ASAP to the make up recording for the 30 day period it is available. I understand that if I choose not to follow the above protocol to make up any class I miss, that I then relinquish my right to make up the class at all.

I understand that in addition to any program or tele-program fee, there will be a need for me to additionally purchase a notebook of my choosing to utilize for the program or tele-program I am taking as well as one to two additional program materials (i.e. a book, dvd and/or scrapbook depending on what I’ve signed up for) that will be used as an addendum to the program or tele-program I am taking. These necessary program materials will be an additional, total cost of somewhere between $10.00 to $30.00 per program/tele-program if purchased within the United States. If purchased outside of the U.S. the cost could be more. It is my responsibility to look into this in advance, if it’s an issue for me.

I understand that when I sign myself up for any class, program or tele-program (including live streams), & make the investment of my time, energy & finances, access to the class(es), program or tele-program is/are for me only & therefore, I agree not to share any of my materials with others who have not made the same investment for themselves. I understand that by doing this I am both respecting myself & all of us who have made the personal investment. I also understand that all handouts, class exercises & materials given to me are copyrighted & the intellectual property of Jen Mac’s Something Different For Women. Therefore, I may not use any of the material in other group settings or on the internet without first gaining written consent from Jen Mac’s Something Different For Women. I understand that if I don’t comply with the above & it is discovered, I will be excused from whatever class, program or tele-program I am a part of & possibly, from the community altogether.

I have read & agree to follow all of the above Community Policies and Privileges & agree to the Terms of Use.

Disclaimer — Jen Mac’s Something Different for Women, LLC

I, [name], hereby declare that I am of sound mind & body while signing up for & participating in any & all classes/programs/tele-programs with Jen Mac’s Something Different For Women.

Furthermore, I understand that all of these classes/programs/tele-programs are taught to enhance my life & merely offer suggestions to me. I understand that all of these classes/programs/tele-programs & the class/program/tele-program leader do not instruct me to do anything I do not wish to do.

I also understand that the program leader for “Something Different For Women, LLC”, Jennifer Macaluso-Gilmore, does not proclaim to be a therapist, guru, PhD. or M.D. of any sort but simply an instructor, teaching philosophies & theories she has learned through her own personal education & growth. It is with the above understandings that I join in this/these class(es)/program(s)/tele-program(s). I understand that my electronic signature below constitutes a legal signature confirming that I acknowledge & agree to the above Disclaimer. My signature will be represented as follows: /First Name Last Name/.

Please type your name below (exactly as it appears above & as stated in the above paragraph, with a forward slash before your first name & a forward slash after your last name):

Jan 22, 2021

Thank you for submitting our one time, uniform request form. You matter! Someone will get back to you within 72 hours.

Best,
Jen Mac & The SDFW Crew

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Please email me a payment link! I’d like to officially reserve myself a remaining spot in "[course]".

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Thank you for submitting your payment request form. You matter! Someone will get back to you within 72 hours.

Best,
Jen Mac & The SDFW Crew

Personal & Professional Development
For Those In Leadership
& Those Feeling Called To Lead

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