Application for Coaching/Consulting

Application for Coaching/Consulting
Thanks for applying! Please fill out and submit the following form--and allow me 7-10 days to respond.

Also, please understand that I want to fully invest myself in my clients; therefore, I am only accepting a limited number of men and women at this time; so you may be placed on a waiting list.

I do appreciate you taking the time to apply, and I look forward to the possibility of working together!
Name*

First NameLast Name
Email*
example@example.com
Position
Phone Number *
Please list your social media accounts (if applicable):

Personal and/or company pages
Instagram
LinkdIn
Facebook
Tik Tok
Other
Please give a brief summary of your business and/or professional situation*
What are your top 3 intentions for your business and yourself in the next 3-6 months?*
What are the main roadblocks you're currently facing that are holding you back from receiving that result?*
What are your foundational beliefs and/or core values that you try to live up to? (Don't over think this one, we just want to get a sense of where you are coming from!)*
What's your life like outside of business?*
What personal challenges do you currently face?*
Specifically, what are you hoping to gain from working with Dirty and Driven?*
Why is NOW the time that makes sense to focus on GAIN.TRAIN.RETAIN?
Please tell us how you found out about us:*
What is your current annual revenue?*

$0-$500,000$500,000-$1 million$1 million-$5 million$5 million-$10 million$10 million- $50 million$50 million+
Roughly, How many employees do you have?*
Please understand this: I offer coaching, and consultation. I am not a trained counselor, psychologist, or mental health professional; nor can I refer you to one. If you have clinical issues, you will have to look elsewhere for help. Do you understand?*

Yes
Please understand this: Working with us will give you the tools, guidance, and leg work to create a Gain, Train, and Retain Program. However, it is not a magic bullet and there will be certain expectations that you and your company must meet in order for it to be sustainable. It will not be easy in the short term, but it is an investment in the long term. Do you understand?*

Yes
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Application for Coaching/Consulting

Please list your social media accounts (if applicable):