Career Alignment, Role Fulfillment & Entrepreneurship Coaching & Mentoring with Damion Jenkins, MSN, RN
6-Month Program - Application
Sign in to Google to save your progress. Learn more
Email *
Name *
First and last name
Phone number *
Which Month are you interested in starting? *
Required
Where do you currently live? (I live in Manhattan, NYC) *
Where are you currently within your Nursing Journey? (Choose One) *
Required
Please choose the characteristics that best describe you on a regular basis (Select all that apply) *
Required
What makes you want to work with me? *
Required
Tell me 3 things you are hoping to get out of working with me? *
Are you willing to be invested in the process of self-transformation? [Comfort does NOT create change - The process of self-transformation requires periods of discomfort as we stretch ourselves to evolve] *
Are you willing to be financially invested? If so, which payment option are you interested in? (Choose payment option below) *
Do you have any colleagues, friends or family that you would like to refer to this program? If so - you will get a 25% discount upon successful enrollment into the program. *
Required
Your application will be reviewed, and I will get back to you with the next steps. *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of The Nurse Speak. Report Abuse
Google Forms