1:1 Coaching Application Form

1

Name* This field is required.

First Name

Last Name

2

Phone NumberYour personal data is never stored. Note: You may receive a text message from Jacob confirming your application.

Please enter a valid phone number.

3

Email* This field is required.Your personal data is never stored.

example@example.com

4

Link Your Main Social Media Handle Below Ex: IG @jacoblovesbeingalive. If you aren't on social media, say N/A.

5

Which dimension of life is most important for you to improve?* This field is required.

Relationships & Intimacy

Leadership & Influence

Wealth & Money Machine

Health & Peak Perfomance

Business & Brand Influence

6

What are the top outcomes or results you want to get in our coaching together?* This field is required.Number them in order of importance. Be as specific as possible.

7

Why are achieving these outcomes a "MUST" for you?* This field is required.I need to know your "BIG WHY" — so put your heart and feelings into this part!

8

Complete this sentence. "I want to become a person who..."* This field is required.

9

What is your current monthly income level?Your personal data is never stored. We ask this question to ensure each applicant can safely afford the coaching experience.

$5-10k

$10-20k

$20-50k

$50k+

I don't have a lot of cash flow but have savings/liquid investments.

10

Are you committed to leaving your comfort zone, accepting uncomfortable truths about yourself, and receiving honest feedback to help you get to the next level?* This field is required.Type "YES" if you consent to this.

11

If you are accepted into this program, are you committed to showing up to the intro call prepared and on time? Note: If you are more than 5 minutes late, you will forfeit your position entirely.Type "YES" if you agree to this.

12

IMPORTANT NEXT STEPS ➡️ Please email the subject "DONE" to jacobmetzger7@gmail.com along with your full name. Or DM Jacob "DONE" on Instagram (@jacoblovesbeingalive) to hop on a call and discuss next steps.You rock! I look forward to connecting with you.