Rise Unlimited™ Application

1

What is your full name?* This field is required.

First Name

Last Name

2

What is your best email address?* This field is required.

example@example.com

Confirm Email

3

What is the best phone number to reach you?* This field is required.Include country code if outside the U.S. Phone or WhatsApp is fine.

4

In your own words, what symptoms have you been experiencing?* This field is required.

5

How long have you been dealing with these symptoms?* This field is required.

Less than 30 days

1 to 6 months

6 to 12 months

1 to 3 years

3 to 5 years

5 years+

6

What have you tried so far to recover?* This field is required.

7

How familiar are you with Jordan's content and recovery approach?* This field is required.

I am very new and have only recently come across his content

I have watched a few of his videos and have a basic sense of his approach

I have followed his content for a while and understand his recovery approach fairly well

8

What do you do for work?* This field is required.

9

Are you able to financially invest in mentorship if it feels like the right fit for your recovery?* This field is required.

Yes

No

10

In your own words, describe your financial situation/ability to invest in this transformation of becoming symptom free* This field is required.

11

Our mentorship requires a financial investment. Please receive support through our free YouTube videos for now.

12

I understand that if I book a call and no-show without notice, I will lose the opportunity be considered for mentorship in the future* This field is required.

Yes, I understand