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Application for Mentoring - Lara Bezerra
Welcome!
I’m honored you’re interested in my mentoring program. This form helps me understand your needs and see if we’re a fit. Answer openly so I can support you best. Questions? Text +1 (407) 861-0151.
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1.
Address
(Required.)
Name
Company
Address
Address 2
City/Town
State/Province
ZIP/Postal Code
Country
Email Address
Phone Number
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2.
What is your actual occupation?
(Required.)
I am an executive - CEO or C-level
I am a board member
I am an executive, Management level
I am an entrepreneur, I have my own business
Other (please specify)
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3.
Is your company paying for you?
(Required.)
Yes
No
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4.
Are you looking for a mentoring program or one individual conversation?
(Required.)
Mentoring program
One individual conversation
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5.
What would you like to transform in your life?
(Required.)
I want to align my work with my life’s purpose.
I want more balance in my life.
I am in an important role and need to be fulfilled.
I want to improve my leadership impact.
Other (please specify and justify)
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6.
Why did you choose my program specifically? What unique opportunities do you see it creating for your personal or professional life?
(Required.)
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7.
Why do you believe that working with you will allow me to create the greatest impact for the world?
(Required.)
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8.
What are your top 1–3 coaching/mentoring goals?
(Required.)
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9.
If our program is successful, what will be different in your life at the end?
(Required.)
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10.
How long do you expect our interaction to last?
(Required.)
One focused conversation for a specific situation.
3 months, 1 session/month — for a targeted challenge.
6 months, 1 session/month — for deeper transformation.
Indefinite — I see value in ongoing mentorship (please explain).
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11.
What is your budget for investing in this area of your life?
(Required.)
I am ready to invest whatever is needed for the right program.
I can commit to the full program rate of USD 1,960 per 2-hour monthly session (before taxes) for the agreed period.
I have a smaller monthly budget (please specify).
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12.
How did you find my program?
(Required.)
Instagram
Linkedin
We worked together
Referred by a client/friend
13.
Is there anything else you would like me to know before we speak?
