Application Purpose
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Private one-on-one coaching
Bold & Visible Breakthrough Program 2020
How did you find out about Bold&Visible?
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Facebook
Eventbrite
Word of mouth
The Monologues
Bold & Visible mailing list
Google
Other
1. Calling and Purpose
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For example, you feel like you know what you’re higher calling or purpose is, you’re cultivating your purpose and sharing it with the world. You have a clear vision for your life and destiny path.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
2. Prosperity, Career and Business
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For example, you’re earning enough to have the resources to thrive, prosper and contribute in life, you’re managing finances effectively, working in a career or as an entrepreneur in a business that is fulfilling, aligned with your values, purpose and potential.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
3. Creativity
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For example, you are experiencing creative flow in your career and or your personal life, playing and having fun on a regular basis, you have some form of creative expression, such as painting, dancing, writing, speaking etc.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
4. Confidence, Voice and Visibility
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For example, you feel the confidence to create what you want in your life, to lead others, to take risks, express yourself fully with others, and follow your inner wisdom/ideas. You speak your truth and stand forward in full visibility with your talents, ideas and creative potential.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
5. Influence and Leadership
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For example, you feel like you’re impacting, uplifting and empowering others regularly, you’re leading the groups and numbers of people you want to be impacting.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
6. Health
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For example, you’re fit, healthy, radiant, vital and have enough energy to do everything you want to do. You support yourself to eat well and stay calm/centered daily. You are relatively stress free and/or have good skills to manage stress. You sleep well and take care of the fundamentals.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
7. Relationships
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For example, you have strong relationships and community around you. You enjoy professional networks and collaborations that you can tap into to leverage your talents and help you grow. You have mentors and people you reach out to for support.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
8. Spirituality
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For example, you feel deeply connected to a higher power and trust life to support you to create, grow and evolve, you trust your inner wisdom to guide and support you.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
9. From points 1-8 (the above areas), which areas of your life reflect the biggest gaps between what you deeply desire and how your life is currently showing up?
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10. What are your biggest challenges, frustrations, and fears related to this?
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11. What do you most yearn to create in this area of your life?
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12. What is the opportunity that you can sense here?
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13. What would be your greatest vision if you had the unlimited power to create it?
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14. What would become possible for you if you were able to have that (the result)?
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15. What’s your #1 burning question you want answered right now to take your next step in this area?
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16. What would you most be looking for in a coach or mentorship program to support you with this?
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Name
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First Name
Last Name
Email Address
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Phone Number
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