Mentorship Application

Name *

First

Last

Email *

Main Phone *

Alternate Phone

Are you hoping to work together in-person in San Luis Obispo or via video-confrencing from anywhere in the world? *

In-Person in San Luis Obispo, California USA
Remotely via Video Conferencing
A mixture of both

When do you hope to start our work together? * *//

How did you hear of me? *

Qualifying Scholarships?

Please read about available discounts and scholarships here.

**Why would you like to receive this scholarship? *

**What do you hope to gain from our work together? *

**How will you take the benefits of your experience out into the world to help others? *

Please tell me more about your current Social Justice Activism *

Please provide a brief statement of your financial need. *

If this one-on-one Intuitive Healing & Mentorship Program is everything you hope it will be, how do you imagine you, your life, your relationships and/or your work will be different on the other side of our time together? *

What are you hoping / expecting to gain from our relationship?

What is it that you really want to be and do? *

What are your aspirations? What do you wish you could be great at doing? Where do you want to see yourself in the next six months?

What motivates you in life right now? *

Where do you get your energy? What motivates and turns you on? What are you passionate about?

What are you doing really well that is helping you get there? *

What is holding you back? *

What are you not doing well that is preventing you from getting there? What are the biggest challenges, self-defeating behaviors or roadblocks you have in your life right now? What could you do less of?

What would it take to live your vision & achieve your goals? What skills, or resources do you think you need to build? *

What might you need to heal?

How much energy are you willing to put into that? *

What are you willing to do in the next 30 days to reach your goal?

What could be your first step to move you in that direction? *

What small steps can you take today to get you closer to your vision? What will you do different tomorrow to meet those challenges?

How can I help? *

What do you most desire / expect from this mentorship relationship? What can I do to help you succeed?

What am I NOT asking you that you really want me to ask? * *

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

Please note: The State of California does not license practitioners of complementary healing arts such as Yoga Therapy, Reiki, Intuitive Healing or Counseling/Mentorship. *

Acknowledgment of non-licensure

Captcha *

What is the second letter of the alphabet?

Intuitive Healing & Mentorship Application

I look forward to connecting with you shortly!

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