Mentorship intake form

1
Hi there! I am so excited to get to know you* This field is required.
First Name
Last Name
2
What program are you interested in* This field is required.
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Please Select
1 month
3 month of coaching
3
Where in the world? What country are you currently living in? * This field is required.
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E-mail- double check this as it's how I will be in touch!* This field is required.
example@example.com
5
What best describes your current reality* This field is required.Feel free to check multiply
I'm really struggling with self doubt and trust in myself
My nervous system feels really disregulated and is impacting my creativity
I know I am creative but feel scared to really show that side of myself
I want to write but I don't know where to start
I have a book already started, but am stuck with how to continue
I'm looking for accountability with my WIP and want to get the story written.
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Let's expand on the above question* This field is required.Share a bit more details about areas in your life that may be a struggle and where you wish to be by the end of the course
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What areas do you need the most support with right now?* This field is required.Mindset, emotions, action/accountability, and or nervous system regulation
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Tell me about your book. What's the idea or current story you have brewing?
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Let's get crazy here-what is your BIG WILD dream life? If you could do, be or have anything what would that be?* This field is required.This can be business, wealth, health, spiritual gifts etc
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Let's think back to your childhood-what did you LOVE to do?Example: When I was a kid my friend and I would play dress up, make houses for faeries and have wild dance parties
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If you are struggling, what is the best way I can support you through it?* This field is required.
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I want to make sure this program feels like a full body yes. Is there any fears or concerns you have about jumping in? * This field is required.
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What support are you looking for in a 1:1 mentorship* This field is required.How can I show up and support you in the best way possible.
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How did you hear about me?* This field is required.
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Instagram
Facebook
Friend
Other
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Anything else that would be helpful to know* This field is required.
Should be Empty: