(Once you submit your application, you'll be sent to my calendar so you can schedule our call.)
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If accepted into this program, Are you financially able to invest in coaching with Arrettres Hollins/Connecting Love and Marriage without requiring approval from your husband
Yes, I can enroll and invest in this program without my husband's approval.
No, I can NOT enroll and invest in this program without my husband's approval.
How long have you two been married?
How many children do you have?
What would you like to be able to do by the end of this coaching program?
Describe your pain point in regards to healing and restoring your marriage. What feelings are you struggling with?
What goal would you like this program to help you accomplish? What is your desired outcome?
What is the #1 question you want answered through this program?
What is the #1 struggle or obstacle you would like removed from your life/marriage right now?
What is the 2nd question you want answered in this program?
What would you like your life to be like after completing this coaching program?
What else have you tried in the past to solve your issue?
Have you worked with a coach, counselor or therapist before?
YES
NO
Describe what worked and what didn't work with past solutions or attempts to solve your problem.
Why are you seeking help now?
What is your long term goal for your marriage?
Is there any other information you would like to share that could help me better mentor you?
Can you tell me a little bit more about yourself? Describe your personality. (I.e. Confident, passive, ambitious, spiritual, etc.) *
Are you interested in working with me privately or semi privately?
Privately
Semi Privately
I need another option
What questions do you have about The Healed & Empowered Wife Accelerator?
Acceptance into this program is limited and enrollment is not guaranteed to everyone. If you are selected, which of these best describes your budget to enroll?
$200 - $400/month
$500 - $1000/month
$2000 - $5000/month
$5000+
How WILLING and ABLE are you to invest in a program that will help you get your life and marriage back on track. *
I have the necessary resources to invest in learning how to get my life and marriage back on track.
I have the ability to get the necessary financial resources to invest in learning how to get my life and marriage back on track.
I have absolutely no financial resources available to me to do anything differently than what I am currently doing and will continue to get the same results that I am currently getting.
If accepted into this program, **All deposits or payments made towards any products or services with Connecting Love and Marriage are all non-refundable. *
Yes, I understand and accept this.
No, I do not understand.
Which traffic source led you to apply today?
Youtube
Email
Instagram
Facebook Group
Event
Blog Post
Friend/Referral
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