Mentorship Application Form

1
Full Name
First Name
Last Name
2
Email
example@example.com
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Phone Number
Please enter a valid phone number.
4
Social Media LinksThis helps me match a face to a name
5
If you could put one message on a billboard for the world to see, what would it say?
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If you could wave a magic wand and solve one issue in the world, what would you change?
7
Why does becoming more courageous matter to you right now?
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What’s the biggest challenge you’ve overcome recently?
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What’s the #1 thing you'd like help with?
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What tangible result(s) is this holding you back from achieving in your life?
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How important is it to you to overcome that challenge and create those result(s)?(1 = not very / 5 = absolutely essential)
1
2
3
4
5
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Why now? What makes this the right moment to pursue this with my support—rather than going it alone for another 6 months, year, or more?
13
The entry-level investment for private 1:1 mentorship is $6,000. If we move forward after our Zoom call and both feel it’s a powerful fit, are you ready and excited to invest in yourself?
YESNO
14
If you qualify for an intro call, to maximize the benefit you receive from our call, do you commit to showing up to the call on time, being in a distraction-free location, and enthusiastic about making real changes in your life?
YESNO
15
Who are 3 of your favorite heroes or heroines—real or fictional?Books, films, anime, games—anything goes.
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: