Mentorship Intake Form
Name:
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Email:
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Phone Contact:
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Age:
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Occupation:
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Country:
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What is your primary motivation for joining this mentorship program?
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What specific challenges or areas of your life would you like to focus on during this mentorship?
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What are the top 3 goals you hope to achieve by the end of the mentorship?
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How would you describe your current level of self-awareness? (On a scale of 1–10)
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What is your biggest obstacle to personal growth right now?
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What do you believe is holding you back from reaching your fullest potential?
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What are you most proud of in your life, family or career right now?
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How committed are you to working on yourself and your goals throughout the year? (On a scale of 1–10)
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What areas of your life do you feel need the most transformation? (e.g., relationships, career, health, personal mindset)
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Do you have a support system in place to help you succeed during this mentorship?
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Yes
No
Unsure
What specific skills or attributes would you like to develop over the course of this mentorship?
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Have you worked with a coach or mentor before? If yes, what was your experience?
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Are you open to feedback and being challenged to think and act differently to achieve your goals?
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Yes
No
What is your primary motivation for making this commitment now? Why is now the right time for you to invest in yourself?
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What values or principles are important to you in a coaching/mentorship relationship?
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How do you prefer to receive feedback (direct, supportive, constructive, etc.)?
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Are you open to working with a faith-based approach in your mentorship?
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Yes
No
Maybe
What do you hope to achieve in the first 3 months of the program?
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What is your budget for the 1-year mentorship program?
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$3000
$7000
$10,000
Custom (Insert Amount)
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Is there anything else you would like me to know as I consider your application for the 1-year mentorship program?
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Schedule a Consultation Call
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Submit
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