The Human Foundation
Participant Intake & Baseline Reflection
Body, Mind, Heart & Spirit — The Four Dimensions of Human Intelligence
Please complete this form after registration and before your workshop.
This intake establishes a starting point for your own reflection and helps the facilitator understand the general needs of the group. There are no right answers. Questions marked optional may be left blank.

This workshop is educational and reflective in nature. It is not therapy, medical care, or diagnosis.
Section 1 — Participant Information
Age Range
How did you hear about The Human Foundation Workshop?
Section 2 — What Brings You Here?
Which of the following best describes your current season?
What brought you to The Human Foundation Workshop at this point in your life?
Is there a current decision, challenge, relationship issue, or transition you may want to bring into the workshop exercises?
What do you most hope to understand, recognize, or leave with by the end of the workshop?
Section 3 — Learning Baseline
For the following statements, rate yourself from 1–5.
1 = Not yet / very little
2 = Slightly
3 = Somewhat
4 = Mostly
5 = Clearly / confidently
I can clearly distinguish Physical, Logical, Emotional, and Spiritual Intelligence from one another.
I can recognize which of these intelligences I tend to rely on most in everyday life.
I have a practical way to consult my body, mind, heart, and spirit together when making an important decision.
Section 4 — Intelligence Balance
Rate each dimension from 1–10 according to your experience in your current season.
1–3: Rarely accessible / frequently ignored
4–6: Accessible but inconsistent
7–8: Regularly available and intentionally practiced
9–10: Deeply integrated in my current season
There is no “winning score.” The purpose is to notice your current pattern.
Physical Intelligence: How grounded, present, and connected to my body am I?
Logical Intelligence: How clear, structured, and discerning am I?
Emotional Intelligence: How honest, compassionate, and emotionally aware am I?
Spiritual Intelligence: How connected to purpose, unity, and deeper meaning am I?
Section 5 — Your Current Pattern
Before the workshop begins, which intelligence seems to lead your life most often?
Which intelligence currently feels least accessible or most neglected?
Which intelligence, if any, do you think you may overuse or rely on too heavily?
Section 6 — Participation & Workshop Readiness
How would you prefer to participate during reflective exercises?
Is there anything that would help you participate more fully or comfortably?
This may include accessibility needs, communication preferences, or practical accommodations.
Is there anything you would prefer not to discuss or be invited to share publicly during the workshop?
You may also pass on any exercise or sharing invitation during the workshop without explanation.
Participant Acknowledgment
Please confirm each statement before submitting.
I understand that The Human Foundation is an educational and reflective workshop and is not therapy, medical care, or diagnosis.*
I understand that participation is voluntary and that I may pass on any exercise or group-sharing invitation without explanation.*
I agree to respect the privacy of what other participants choose to share during the workshop.*
I understand that my intake responses may be reviewed internally to support facilitation and program evaluation. My words will not be used publicly as a testimonial or quotation without separate permission.*
If the workshop brings up concerns requiring support beyond the scope of the session, I understand that I am responsible for seeking appropriate professional or personal support.*
Participant Name / Electronic Acknowledgment:*
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