1. ➔Full Name *

3. ➔Phone *

4. ➔Email *

6. ➔Select all that apply to you? *

I_Need_Help_With

7.➔What state do you live in? *

State_You_Live_In

8. ➔On a scale of 1-10 how well do you communicate? *

🟥1-3: To be honest, I need to work on this

🟨4-7: Good but it could be better

🟩8-10: I respect and value communication