Career to Entrepreneur APPLICATION FORM

1
Name
First Name
Last Name
2
Email
example@example.com
3
Where do you live? Please include your city and country
4
How did you find out about me?
5
Are you currently working full time, and if so what is your current job title? What do you do and who do you work for?
6
Are you looking to start your own business? Tell me a little about what you're looking to achieve (including any business ideas you already have).
Huge
Large
Normal
Small
Ok
Ok
7
Have you completed my ‘Find a new Career in 30 Days program?’ If not, please state where you are up to and your experience to date.
Huge
Large
Normal
Small
Ok
Ok
8
What are your biggest challenges that you would like me to help you with?
Huge
Large
Normal
Small
Ok
Ok
9
On a scale of 1 – 10 how important is it for you to solve these challenges?
10
What’s the #1 biggest obstacle that has kept you from solving these challenges? Have you taken any steps to solve these challenges? If so, what didn't work?
Huge
Large
Normal
Small
Ok
Ok
11
What do you think you’ll need to shift in yourself in order to reach your goals?
Huge
Large
Normal
Small
Ok
Ok
12
What budget have you set aside (or can make available) for mentoring and investing in the growth of yourself and your dreams?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
13
Is there anything standing in the way of you taking action to move forward? (time, money, previous commitments?)
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: