Application Form - The Kind Voice of Impact Speaking and Certification Program

Application Form –

The Kind Voice of Impact™ Speaking and Certification Program

🚀 Apply now to be considered for one of the 12 exclusive spots in this transformational 16-week program!

📝 Application Fee: $299 CAD + tax (fully refundable if not accepted)
⏳ Deadline to Apply: May 17, 2025

👤 Personal Information

Full Name *

Email address *

Phone Number *

City & Province / State *

Country *

LinkedIn Profile (if applicable)

Facebook Account (if applicable)

Instagram Account (if applicable)

Website (if applicable)

🎤 Speaking & Communication Experience

1. What is your current level of speaking experience? (Check one) *

Beginner – I have little to no experience speaking publicly.

Intermediate – I have spoken in meetings, events, or small engagements.

Advanced – I have spoken at conferences, keynotes, or professional stages.

2. What are your main goals for this program? (Select all that apply) *

Build confidence in public speaking

Craft a powerful signature talk

Improve vocal variety and stage presence

Learn how to connect deeply with an audience

Prepare for paid speaking opportunities

Strengthen my communication skills for leadership/business

Please state any other goals here:

3. What topics are you passionate about speaking on? *

4. Have you ever spoken on a stage, podcast, or video platform? If yes, please share details (where, when, topic and if what you charged). *

5. Do you have a signature talk or speech idea in mind? If yes, please describe. *

6. What do you believe is your biggest challenge when it comes to speaking? *

🗣 Why You?

7. Why do you want to be part of this program, and why do you feel it’s the right time for you? *

8. This program is live and interactive. Can you commit to attending the weekly sessions (Thursdays 12–1 PM ET) and the final live showcase in November (date to be confirmed)? Note that if you are unable to attend, do you commit to watching the recording prior to the next session? *

Yes

If no, please explain:

9. This program includes mentorship, coaching, and hands-on practice. Are you open to receiving feedback and actively participating? *

Yes

10. What does “kindness” mean to you in the context of your speaking career and how do you plan to use your speaking platform to contribute to a kinder or more socially responsible world? *

💰 Payment & Commitment

11. If accepted, are you prepared to commit to the remaining full investment of $5700 CAD + tax (paid in 3 installments)? *

Yes

If no, please explain:

If you have selected 'Other' or 'Referral' please provide details:

📢 Final Agreement

🔹 I understand that submitting this application does not guarantee my acceptance into the program.
🔹 If my application is not approved, my application fee will be fully refunded.
🔹 If accepted, I agree to fully participate, respect the cohort, and be engaged throughout the program.

🔹 If I choose to withdraw after being accepted, I understand that my application fee is non-refundable.

Application Fee: $299 CAD + tax (fully refundable if not accepted). Please select: *

CA$ 337.87

Signature: *

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Date: *

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