1:1 Mentorship Intake Form

NAME*

First NameLast Name

EMAIL*

example@example.com

What pulled you toward this mentorship, and what part of you knows it’s time for change?*

When you imagine your future self 12 months from now, what feels different inside and outside?*

What patterns or habits have you noticed that keep pulling you back into the same place, even when you know better?*

When things get uncomfortable or confronting, what’s your usual response, and what would it look like to choose differently this time?*

When it comes to feedback, how do you prefer it, direct and hard-hitting or softer and more nurturing?*

Everyone says they want to change, but few do the basics well. What does “doing the basics well” mean to you personally?*

If this mentorship gave you everything you need, clarity, tools, and accountability, what are you willing to bring to the table to make that transformation real?*