Mentorship Registration Form

Mentorship Registration

Complete the form below to sign up for our mentorship service.
Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*

Area CodePhone Number
Preferred way to contact*

PhoneEmailAny
Where did you hear about us?

A Friend or colleaugeSocial MediaPrevious ClientOther
Mentee Questionnaire

Please answer all questions to your best ability.
Are you currently a buisness owner?*

YesNo
If so, what is(are) your business avenue(s)?
How do you stay competitive in your industry?
Where do you ultimately want to end up in your career (role, title, income, etc.)?*
What inspired you to want to pursue this work?*
If you could learn any new professional skill (it doesn’t have to be related to your current role or industry), what would it be?*
What are your short-term goals?What are your long-term goals?*
What is the motivation behind your goals? Why are they important to you?*
Do you have any habits that hinder your success?*
How often do you check-in with yourself about your thoughts, feelings, and actions?
How committed are you to change?
scale 1-10
Mentorship Availability & Expectations
What days of the week are best for mentoring?*

MondayTuesdayWednesdayThursdayFriday
Wha time(s) are the best for mentoring?*

MorningAfternoonEither
Do you perfer in person meetings or video chat meetings?*

In PersonVideo ChatEither
What are you looking to get out of your mentorship with Keyona Squire?*
Have you had a mentor in the past? What was that experience like for you?*
Should be Empty:

Mentorship Registration

Mentee Questionnaire

Mentorship Availability & Expectations