1:1 COACHING application form Name * First Name Last Name Email * Location What prompted you to reach out now? What are your 3 biggest goals? 10 being VERY commited, how committed are you to achieving your goals? 10 [very committed] 9 8 7 6 5 4 3 2 1 [not committed at all] Which of these best describe your struggles? Emotional inflexibility and immaturity Stuck and unable to move forward Low or missing self confidence Disconnected from your deep self Unsure of what to do in today's climate and world Choosing unhealthy ways of living Where do you need most support right now? What lights you up and motivates you? The world needs what you have inside of you, and it needs it now. I am here to safely guide you to access repressed areas of emotion and and desire, resulting in relaxed confidence and higher performance. I am willing to meet you where you are if you feel a FULL YES for our work together. In order to receive an insight into your situation, please choose from the options below the statement that best describes your current capacity to commit and invest in yourself. Coaching is $1800 a month. I have the necessary financial resources to invest in myself. I have to create opportunities to be able to invest in myself. I don't have the financial resources available to me at this time and don't see possibilities to create them. I am incredibly ready and committed and would like to apply for a scholarship. Is there anything else you like to share? Phone Country (###) ### #### Thank you for being vulnerable. I will get back to you shortly.
