Apply for VIP Day Coaching with Jessica

1
What is your full name?* This field is required.
First Name
Last Name
2
What's your best email so we can send your acceptance letter?* This field is required.
example@example.com
3
What's your best telephone number if Jessica needs to reach you?* This field is required.
Area Code
Phone Number
4
How did you find out about Jessica? If someone referred you, please let us know.* This field is required.
5
Tell us what inspired you to want to work with Jessica specifically.* This field is required.
6
Which area of your life do you most want to focus on right now? (Choose one or more)* This field is required.Check all that apply
Business / Career
Health/Fitness
Relationships
Leadership/Personal growth
Other
7
What do you value most in a coach?
8
What has been your biggest challenge in making progress on your own?* This field is required.Choose all that apply
I have lots of ideas and sometimes struggle on my own to stay focused.
I'm the most motivated in my circle, so no-one really holds me accountable or sets the bar higher.
I know I have it inside me, but I often suffer from Imposter syndrome and worry that I'll never fulfill my greatest potential and make the difference that I want to make.
I'm constantly busy and find myself burnt out or overwhelmed.
I'm a workaholic and so my health or personal relationships suffer.
I don't have the right kind of support.
I don't have a clear purpose or vision for my life or career
I struggle to stay organized
I struggle with follow through
Other
9
What worries you the most right now?* This field is required.Check all that apply
That I'm running out of time to achieve what I want
That I'll have to sacrifice a lot to accomplish the big goals I have
What people will think of me if I go after what I really want in life
That my bad habits will sabotage my success
That I don't have the right support
My current health
My current relationship with my spouse or significant other
Other
10
Just so we know, which of the following best describes your current status?* This field is required.
New business owner just getting started
Experienced business owner struggling to sustain or grow
Happy in my job or career
Unsatisfied in my job or career
Retired
Other
11
Coaching is a meaningful investment of both time and financial resources.* This field is required.
Yes, I am financially prepared to invest in coaching.
Possibly, depending on the structure of the investment.
No, I am not in a position to invest right now.
12
I have a maximum total budget for coaching over the next 6–12 months of: _________
13
Once I review your application, we’ll schedule a brief 15-minute Application Review Call.* This field is required.
Yes, I’ll do it twice if needed I'm a hard worker!
Can't lie, I'm not going to do it
14
Almost done! Once I review your application, we’ll schedule a brief 15-minute Application Review Call. * This field is required.
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