Mentoring Application

Name*

First Last

Your business name*

Phone number:*

Address:*

Your Email Address:*

Business website URL: https://*

Please tell me about your business. How long have you been in business? Whom do you serve, and how?*

What do you love about your business?*

What are the biggest challenges you face in your business?*

What brings you to me at this time? What would you like to accomplish by working with me?*

Is there anything else you’d like me to know about you?*

Finally, how did you connect with me? If you have taken a class or program with me, or had a single strategy session with me, please let me know that too.*

I am interested in...*

a 3-month mentoring immersion
discussing another project or mentoring option

When would you like to begin your program?*

Now or as soon as an opening becomes available
In the next three months

Please save a copy of your responses for your own records before submitting the form online.