One Connection Away Podcast Intake Form
Thank you for being open to joining One Connection Away — a life-first, connection-driven podcast hosted by Jenny and Steve. This form helps us get to know you before we record so the conversation feels natural, meaningful, and aligned.
Podcast Venue & Schedule
3042 S Durango Dr, Las Vegas, NV 89117 | 1st & 3rd Tues 9:30am -12pm
Appointment
Basic Information
Full Name
Preferred Name (how you like to be addressed)
Organization / Business Name
Your Role / Title
Type a question
Email Address
Phone Number
Website
You, Beyond the Title
How would you describe yourself outside of your work?
What life experience has shaped you the most?
What season of life are you currently in?
Your Journey & Mindset
What belief did you have to let go of to grow?
How has your definition of success changed over time?
What lesson did life teach you the hard way—but you’re grateful for now?
Connection & Relationships
How have relationships or community played a role in your journey?
What makes a connection meaningful to you?
Was there a person or moment where one connection changed everything for you?
Your Work & Organization
What do you do now, and why does it matter to you personally?
Who do you feel most called to serve through your work?
What impact do you hope your work has on others?
Collaboration & Opportunities
How can people best collaborate or connect with you?
Are you currently open to any of the following?
Partnerships / Collaborations
Speaking Opportunities
Podcasts / Media
Referrals
Community Projects
Other
If “Other,” please specify
What types of connections would be most valuable to you right now?
Looking Ahead
What are you currently building, growing, or exploring?
Who would you love to connect with next—and why?
Final
Is there anything you’d love us to know before the podcast conversation?
Consent
Recording & Sharing Consent
Yes, I’m comfortable with this conversation being recorded and shared on podcast and social platforms.
Not yet — I’d like to discuss first.
Signature
Continue
Continue
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