Interested to see what mentoring is like? Experience a free mentoring session Please enable JavaScript in your browser to complete this form.Who am I and who are you? Mentoring, as a modality of connecting with and caring for an individual, is a process of sharing my experiences with others who are experiencing or hope to be experiencing similar. As a heterosexual male in a long-term, committed, monogamous relationship, I am most effective when offering my experience to men who are, hope to, or are struggling trying to live similarly. While I am quite happy to offer this free session to anyone, despite affinity to or similarity to myself, please understand that I am only as effective a guide as my experiences have led me to be.Gender *MaleFemaleAge *Name *FirstLastEmail *EmailConfirm EmailPhone *Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryI won't send physical mail to your address, but your address helps me validate you're a real person. Also, as a business professional, this information goes into my CRM system so that I may better serve you and keep professional records.Best time to call (include timezone pls) *What do you do for a living?Marital StatusSingleMarriedSeparatedDivorcedWidowedIn a relationshipHow long?Do you have children? *YesNoWhat led you to contacting me today? *What changes would you like to see the most in your life? *What do you see as the biggest barriers to these changes you desire? *Do you struggle with any addictions? *NoYesPlease explain how you struggle with addictions *Have you had any issues with Depression, Anxiety, or ADD/ADHD (Attention Deficit Disorder/ Attention Deficit Hyperactivity Disorder)?NoYesPlease explain what issues you have or have had with depression, anxiety, ADD/ADHD *Are you currently seeing a therapist? *NoYesPlease explain why you are receiving therapyHow many books do you read in a year? *How serious are you about beginning a mentoring program? *I’m just looking into it but not ready to make a time or money investment in myselfI’m serious and want to invest in myself, but I don’t know how to get goingI’m ready to get going and make the necessary investments to do itWhat do you believe must happen in your life before you'll be ready to make such an investment into yourself?How did you hear about me?Help me get to know you a bit with a fun questionWhat kind of vehicle do you drive?This just helps me to get to know you personally. Tell me as much or little as you want!What kind of vehicle do you WISH you were driving?This just helps me to get to know you personally. Tell me as much or little as you want!A bit more about how you engage lifeThese questions help me provided the best mentoring experience I can for youDo you get your energy from interaction with the world and people around you, or more from yourself, with your own activities and thoughts? *The world around meMy own activities and thoughtsDoes your info preferably come from observing, measuring, experience or from explanation, reasoning, more abstract understanding? *From observing, measuring, experienceFrom explanation, reasoning, more abstract understandingHow do you make most decisions: by way of rational, logic, given decision criteria, or by looking at context, interests, what feels right? *By Rational, logic, given decision criteriaBy looking at context, interests, what feels rightHow do you approach situations: should things go as planned and wanted, or are you flexible, open to change, go with the flow? *I want things to go as planned and prefer black and white, concrete stepsI am flexible, open to change, and go with the flowWould you like to receive a very occasional email newsletter? *YesNoNew emails are only sent when new blog posts or articles are posted or when I have new courses or materials available. PhoneSubmit I’m Looking Forward to Speaking With You!
