Dating & Relationship Mentorship Application

1
Full Name (Required)* This field is required.This form is to provide us with information about you and your situation so we can best serve you during your 30-min relationship coaching session with us.
First Name
Last Name
2
Best Email Address (Required)* This field is required.
jane.doe@yahoo.com
3
Country of Residence* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
United States
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Afghanistan
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Other
Country
4
Age* This field is required.
18-24
25-34
35-44
45-54
55+
5
Gender* This field is required.
Male
Female
6
How did you learn about us?* This field is required.
YouTube
LinkedIn
Instagram
Facebook
TikTok
Email Campaign
Other
7
What's your current relationship status* This field is required.Select all that apply.
Single
Dating
Engaged
Married
Divorced
Widowed
It's Complicated
8
What's your current student and/or work status* This field is required.Select all that apply.
Undergraduate Student
Graduate Student
Full-Time Employed
Part-Time Employed
Self-Employed
Unemployed
9
What is your biggest hurdle or obstacle in your single or dating life? * This field is required.Please be descriptive. Tell us about the challenges you're facing and what you've already tried.
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10
What is your primary goal for working with a dating & relationship coach? * This field is required.Be specific. What would "success" look like to you?
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11
What are you interested in?* This field is required.Select all that apply.
One-on-One Coaching (Program)
Group Coaching (Program)
Self-paced Course with 1 Coaching Session Follow-up
I Just Want to Seek Advice for My Situation on this 30-min Coaching Session
12
On a scale of 1–10, how ready are you to commit to a coaching program right now — considering your finances, time, and mental capacity?* This field is required.(1: Being Not Committed - 10: Being All In)
13
On a scale of 1–10, how ready are you to commit to a coaching program right now — considering your finances, time, and mental capacity? And explain why you chose that number.* This field is required.(1: Being Not Committed - 10: Being All In)
14
On a scale of 1–10, how ready are you to commit to a coaching program right now — considering your finances, time, and mental capacity? And explain why you chose that number.* This field is required.(1: Being Not Committed - 10: Being All In)
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15
30 Minute Coaching Session * This field is required.
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ORDER SUMMARY
Total costUSD
30 Minute Coaching Session(Press the blue + plus button). This is focused, breakthrough session designed to help you gain clarity on your situation, understand what God is revealing, and identify your next steps in love, healing, or preparation for marriage. We’ll help you uncover the root of your concerns, receive biblical insight, and walk away with practical direction you can apply immediately. Perfect for singles, dating couples, or those seeking wise, godly guidance before making major relationship decisions.
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