[re] Naissance

Name

First

Last

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Email

Phone

Age

Your professional occupation

On a scale of 1 to 10 (1 = very low, 10 = very high), how would you rate your overall self-confidence?

Selected Value: 0

What specific situations challenge your self-confidence the most?

If you ticked the box "other", you may specify here:

How would you describe your personal style?

Do you feel your style reflects your personality?

Yes, completely	Somewhat	Not really	Not at all	I don't know
Yes, completelyYes, completely	SomewhatSomewhat	Not reallyNot really	Not at allNot at all	I don't knowI don't know

How satisfied are you with your overall appearance (clothing, grooming, and posture)?

Very satisfied	Satisfied	Neutral	Unsatisfied	Very unsatisfied
Very satisfiedVery satisfied	SatisfiedSatisfied	NeutralNeutral	UnsatisfiedUnsatisfied	Very unsatisfiedVery unsatisfied

Is there anything specific you’d like to improve? (e.g., fit of clothing, accessorizing, grooming):

very occupation Program?

Do you feel your current hairstyle complements your personality and style?

Yes, completely	Somewhat	Not really	Not at all	I don't know
Yes, completelyYes, completely	SomewhatSomewhat	Not reallyNot really	Not at allNot at all	I don't knowI don't know

Have you ever received professional advice on your hair type, color, or style in relation with your unique personality and morphology?

Yes
No

How comfortable are you with expressing yourself in important situations (e.g., interviews, presentations, networking)?

Very comfortable	Comfortable	Neutral	Uncomfortable	Very uncomfortable
Very comfortableVery comfortable	ComfortableComfortable	NeutralNeutral	UncomfortableUncomfortable	Very uncomfortableVery uncomfortable

Do you feel your communication style aligns with how you’d like to be perceived?

Yes	Somewhat	No
YesYes	SomewhatSomewhat	NoNo

What is your primary goal for joining the Renaissance Program?

If you ticked the box "other", you may specify here:

What are your top priorities?

	High priority	Neutral	Low priority
Self-confidence	High prioritySelf-confidence High priority	NeutralSelf-confidence Neutral	Low prioritySelf-confidence Low priority
Style	High priorityStyle High priority	NeutralStyle Neutral	Low priorityStyle Low priority
Hair	High priorityHair High priority	NeutralHair Neutral	Low priorityHair Low priority
Communication	High priorityCommunication High priority	NeutralCommunication Neutral	Low priorityCommunication Low priority

Are there any specific upcoming events or situations you’re preparing for?

If you ticked the box "other", you may specify here

Have you received feedback from others about any of the following? (Check all that apply)

If yes, what type of feedback have you received? (e.g., positive, constructive, neutral):

What would success in this program look like for you?

Is there anything else you'd like us to know about your needs or goals?

Desired contact method

Email
Phone
A personal visit at your home
A personal visit in our hub maison ALBUM

Language

Luxembourgish
French
German
English

Desired Times to be contacted

Early Mornings (Before 8am)
Mornings (8am - Noon)
Afternoons (Noon - 5pm)
Evenings (After 5pm)

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