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Application for VIP Mentorship with Deborah Hurwitz

I’m so glad that you’re here!

Please answer these questions as thoroughly and honestly as you can, so that I may provide the best possible guidance moving forward. Your confidentiality is assured and I will be the only person reviewing your answers.

I look forward to learning about you.

First Name

Last Name

Email

Phone

1. Give me a snapshot of your current occupation and living situation:

2. What are you most keen to accomplish, professionally or personally, in the next year?

3. Do you have an important project or goal that isn't getting done?

Yes No

4. What do you think gets in the way of your progress?

5. If I could wave a magic wand and put you on the road to MASSIVE success on your most important goals and dreams, what results would you be excited to generate?

6. How committed are you to achieving these results?
Please select on the scale from 1-5, with 1 being not at all and 5 being very much.

1 2 3 4 5

7. Do you have systems or structures in place to help you get things done? If so, how are they working out?

8. If you found a program, system or mentor that you honestly believed could help you achieve your most ambitious goals, would you be ready to commit NOW?

YES, I'm UNWILLING to keep going this way and am truly ready for a change in my life. Yes, but I have a hard time believing that anything out there can really help me. Maybe, but I have concerns that could hold me back. No, I really can't.

9. Why are you interested in working with me, specifically?

10. Are you mentally and financially prepared to invest in solving the problems that have held you back until now?

Yes, absolutely! I don't think so.

11. Anything else you'd like to ask or share?

I appreciate your time and bandwidth, and will respond to your application within three business days. Thank you!

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