Preliminary Application

Basic Information

 

Tell Me About You

What is your name?

What is your email?

Address

Phone

Skype username


Please tell me about your life and how your condition affects your life, right now.

What are the biggest struggles are dealing with, right now?
What goals would you like to accomplish together? (name at least 3)
What is the number #1 obstacle to achieving these goals? What’s slowing you down or stopping your progress?
What else have you tried to achieve your goals?
What helped and what did not?
What are you currently trying, if anything?
On a scale of 1 - 10, how motivated are you to take massive action and see results to achieve these goals?

I understand that by filling out this application, I am interested in the Wellspring Stones 1:1 programs. At this point in time, I understand I am showing only my interest in mentoring and am under no obligation to make an appointment or make payment. Before acceptance into this program(s), I may be requested to have a 15 minute interview with Cassandra to ensure a 100% win-win + perfect fit. I understand that if I am accepted, after reviewing and submitting my payment contract (supplied after this document is received and approved), I am committed to the program for its duration. I understand my role and the role of my mentor in this program. I will ask questions and clarify anything I don’t understand. I am committed to doing everything I need to do to get 100% from the program. I understand that a separate payment contract will be submitted to me for my review after this application is accepted. By entering my name in the space below, I agree to the terms above and submit my application for review:


thank you!

I appreciate your time and will get back to you as soon as possible!

Name *
Name
On a Scale of 1-10, with 1 being not at all likely and 10 being ready now, how motivated are you to take massive action and see results on your goals?