Prospective Mentee Meeting Request

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What 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? *

Please explain how you struggle with addictions *

Have you had any issues with Depression, Anxiety, or ADD/ADHD (Attention Deficit Disorder/ Attention Deficit Hyperactivity Disorder)?

Please explain what issues you have or have had with depression, anxiety, ADD/ADHD *

Are you currently seeing a therapist? *

Please explain why you are receiving therapy

How many books do you read in a year? *

Average Annual Income *

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 myself
I’m serious and want to invest in myself, but I don’t know how to get going
I’m ready to get going and make the necessary investments to do it

What do you believe must happen in your life before you'll be ready to make such an investment into yourself?

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Prospective Mentee Application