Mentorship Application Form

1

Full Name* This field is required.

2

What is the best email to reach you at?* This field is required.

3

What is the best phone number to reach you at?* This field is required.

5

If you chose referral, who referred you?We want to thank them!

6

On a scale of 1-10, how would you rate your current overall mindset?* This field is required.

1
2
3
4
5
6
7
8
9
10

I'm frustrated and feel hopeless (poor)

I practice mental fitness daily (excellent)

8

What are you hoping that I can help you with if we agree to work together?* This field is required.

9

What is your biggest obstacle to hitting those goals?* This field is required.The more honest you are here, the faster we'll get clear on your next steps.

10

How much are you willing to invest in your mindset right now?* This field is required.

Less than $400/month

$400-600/month

$600-800/month

$800+/month

11

If my coach advised me to get rid of any unhealthy activities that are affecting my overall mindset, I would...* This field is required.

Follow the process and trust that it would help me strengthen my mindset

Be a little bit hesitant, but do it anyway because I'm serious about reaching my mindset goals

Avoid it at all costs - I enjoy torturing myself