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Worksheet

MW 2025/2026 Equity Seat Request Form

I offer discounted “Equity Seats” for BIPOC women, rooted in a reparations framework/mindset. This is one way we at Beth Berry Coaching contribute to Black, Indigenous, Latinx, Asian, and mixed-race mothers struggling on the front lines and navigating the intersectionality of their identities. I see you, and I greatly value your presence in this space and contribution to this experience.

1. ➜

Name

2. ➜

Email

3. ➜

Do you consider yourself a Black, Indigenous, Latinx, Asian, or mixed-race mother?

4. ➜

Do you have any questions, comments, or concerns about participating in this offering as a BIPOC mother?

5. ➜

Please describe what you’re hoping to gain from MotherWorthy.

6. ➜

How committed do you feel to this experience and what desire and/or need is that commitment rooted in?

7. ➜

Which equity seat amount are you requesting?

8. ➜

Are you requesting the equity seat for virtual or in-person MotherWorthy?

9. ➜

*Important Note: Once you've submitted this application, you will be hearing back from my team one way or another. Please check your spam folder if you don't receive a response by September 15th. Click "Save Worksheet" below to submit your request.

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