Affluent Academy Application Form

1

Which of the following best describes you?* This field is required.

I want to start and agency

I already have an agency

2

Are you aged 18 or over?* This field is required.

YESNO

3

What is your name?* This field is required.

First Name

Last Name

4

What is your email?* This field is required.

example@example.com

5

What is your phone number including country code?* This field is required.IMPORTANT: We cannot accept you without the country code

Example for UK, include +44, for USA, include +1 (make sure you do this for your country)

6

What is your current monthly income?* This field is required.

$2k /month (or less)

$2k-$4k /month

$4k-$6k /month

$6k+ /month

7

What is your current monthly revenue?* This field is required.

$2k /month (or less)

$2k-$5k /month

$5k-$10k /month

$10k-$15k+ /month

$15k-$20k /month

$20k+ /month

8

Describe your motivation for starting / growing an Agency?* This field is required.IMPORTANT: Generic answers like "looking to start an agency" won't be accepted

9

What is your desired monthly revenue goal with your Agency?* This field is required.

$1,000 - $5,000

$5,000 - $10,000

$10,000 - $20,000

$20,000 - $50,000

$50,000 - $100,000

$100,000+

10

What do you feel is your biggest obstacle to hitting your monthly revenue goal?* This field is required.IMPORTANT: Be as specific as possible, what are you most hoping to gain from the Academy?

11

If you're accepted how soon can you get started?* This field is required.

12

How long have you been following Alex and CIRCLE12 Academy?* This field is required.

Less than 1 week

A few weeks

Several months

Multiple years

13

If we were to Guarantee in writing that you would sign at least 5 clients, would you be willing (and able right now) to invest in getting the help necessary to get there?* This field is required.

No, I don't have capital to invest in starting an Agency

Yes! I am ready to invest in myself!