Apply for the 1:1 Mentorship

NAME

First NameLast Name
EMAIL
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
LOCATION

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
What made you feel ready to apply for this mentorship?
What’s the biggest challenge you’re currently facing in your life or relationships?
What do you want to feel, create or change by the end of this mentorship?
Have you previously worked with a counsellor, coach, or group program?
If you answered YES to the above, What did you learn from that experience?
If you answered NO to the above, What’s led you to seek support now?
This mentorship involves weekly calls and daily communication. Are you able to commit to that level of engagement for 8 weeks?
How would you rate your current emotional readiness for this work?

1

2

3

4

5

1 is Worst, 5 is Best
How would you describe your current level of self-awareness?
The investment for this 8-week Mentorship is $5,000 AUD (with a two-part payment plan available). Are you financially ready to invest in yourself at this level?
If accepted, when would you like to begin?

DayMonthYear
Date
In your own words, what does “emotional leadership” mean to you?
Is there anything else you’d like us to know before reviewing your application?
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