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Shannon Von Burns - Coaching Application
I am so delighted by your interest in working with me. I would love to meet you in person and get to know you and your goals better. I will get back to you with 24 business hours after you have completed your application.
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Full Name
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Email
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Country
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Age
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Occupation
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Job Title
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Gender
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Female
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Other:
Marital Status
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Single
Married or Domestic Partner
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How do you feel about your current age?
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Age is just a number
I feel older than my age
I feel younger than ever
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Please briefly describe how you have heard about my coaching services and why you would need a Strategy Session with me:
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Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? Please rate yourself: '1 = I have no clue' to '10 = I am totally clear'
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Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? Rate yourself: '1 = I am mentally and physically drained out' to '2 = I am fully energized, vitalized and charged.'
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Do you take action and consistently express who you truly are and what you truly think, need, and desire with the world? Rate your self: '1 = I am fearful, timid and weak' to '10 = Courage and fearlessness are my middle names.'
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Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? Rate yourself: '1 = I am all over the place, unfocused and day-dreaming' to '10 = I am attentive and am producing desired results.'
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Do you feel you have social influence with your family, friends, and team needed to accomplish your goals? Rate yourself: '1 = I feel powerless' to '10 = I have full authority, impact, and leverage.'
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What are your top three goals you must achieve in the next twelve months?
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Why must you achieve these goals now?
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What are the top three things that are holding you back?
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What are you most proud of and excited about in your life?
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What are the characteristics that you admire/respect most in yourself or others?
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What goal or dream have you ever given up on or failed at, and what do you believe caused you to stop or fail?
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What major stressors or challenges are you struggling with right now?
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What would your dream life look like if you could wave a wand and make it happen?
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Briefly describe your current state of health as it pertains to the following: Sleep, Digestion, Energy, Mood, Fitness level, Sexuality
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