The Nutritious Life Studio Student Questionnaire We’re so happy you’re joining us! Now help us get to know you better! Name* First Last Email* Enter Email Confirm Email City* State Country* Birthday*YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920MM123456789101112DD12345678910111213141516171819202122232425262728293031How do you identify?* Male Female Non-Binary Transgender Intersex I prefer not to say My gender is not listed Highest level of education completed*GEDHigh School DiplomaAssociates DegreeBachelors DegreeMasters DegreePhDMDPrefer not to sayMajor/Degree Other Credentials/Certifications (if applicable) What do you do for work? What do you do in your personal time?We want to get to know you! Tell us about how you currently spend your work time and your personal time. Do you work, and if so what do you do? Do you counsel others? Do you teach cooking or fitness classes?Do you currently identify as any of the below? (Check all that apply) Registered Dietitian Personal Trainer Yoga Teacher Pilates Teacher Group Fitness Teacher Health Coach Life Coach Chef Nurse Doctor Nutritionist Stay-at-home-mom Tell us about your goals!What do you hope to do with your Nutritious Life Certification?How did you hear about us? Did someone refer you?What is your Instagram Handle? What is your Facebook Page Link? What is your Youtube Page Link? Do you have a personal or business website? NameThis field is for validation purposes and should be left unchanged. Δ
