1:1 Mentoring Application Form

WELCOME

1:1 Mentoring Application Form

I offer two distinct containers for those ready to see clearly and move accordingly.

The 45-minute Consultation is a focused, high-level space designed to address specific questions or decision-points that require a precise, multidisciplinary lens.

The 90-minute Mentorship is an intensive deep-dive for those at a significant threshold of identity or direction, designed to reorganize how you understand yourself and the inherited systems you inhabit.
Please note: This work is not therapy or ongoing support. It is designed for individuals who are able to self-regulate and are seeking clarity, not care. Sessions are direct and may challenge existing ways of seeing.
Contact Information

Section 1
1. Name*
2. Email*
example@example.com
3. Location (City/Country)*
Context

Section 2
4. What brings you to request a session at this time? (Please be specific. What is the situation, question, or threshold you are navigating?)*
5. What feels misaligned, unclear, or unresolved right now?*
6. What outcome are you hoping for from this session? (e.g. clarity, direction, confirmation, challenge, perspective)*
Readiness

Section 3
7. What have you already explored or tried in relation to this situation?*
8. What feels at stake for you in seeing this clearly?*
9. How do you typically respond when something challenges your current self-concept or way of seeing?*
Fit

Section 4
YesNoUnsure
YesNo
(If yes, this is not the appropriate container.)
12. Is there anything else you would like me to know before I review your application?*
Should be Empty:

WELCOME

1:1 Mentoring Application Form

I offer two distinct containers for those ready to see clearly and move accordingly.

Contact Information

Context

Readiness

Fit