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Be extraordinary
Application form for "Reconnect to Rise", a two months transformational coaching and mentoring programme
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Email
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Record my email address with my response
Are you ready to uplevel?
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YES!
no
Your First Name, or how you want to be called
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Your answer
Your 2nd/last Name
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Your answer
Your preferred pronouns
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Your answer
What are you looking for help with?
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Your answer
What do you think is your biggest obstacle to achieving this?
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Your answer
How do you think working with Nicolina will change things for you?
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Your answer
What steps have you taken before to get your breakthrough?
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Your answer
What would be your ideal outcome be at the end of the three months?
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Your answer
Are you ready and able to invest into yourself?
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Yes
No
How would you rate your overall life satisfaction?
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Not happy with my life
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10
Life's pretty awesome
How would you rate the issue/area you want to transform
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Situation is not great
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I am already where I want to be
How have you found out about this programme?
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Your answer
Are you aware that with any coaching journey, Nicolina can coach, mentor, teach or guide you, but ultimately the results you get will be up to you?
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Yes
No
Are you aware that coaching and mentoring does not replace therapy or medical help if you should require it?
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Yes
No
Anything else you would like us to know about you?
Your answer
And in what time zone are you currently?
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Your answer
Thanks for your time.
We will be in touch soon.
Send me a copy of my responses.
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