Make 2017 Exceptional! Be Kick A$$

By completing the application below it will help me assess you and what it is you want to achieve. I don’t take this part lightly, the fact you are applying tells me a lot about you already. ~ “You are a Go-Getter Dad and are ready to KICK ASS!”

Once I receive your application I will review it and connect with you to set up a 30-minute interview call to discuss your needs in more detail. This process will ensure you meet the criteria for mentoring with the HERO WITHIN concept and work one-on-one with me and my partners. It will help me assess your current situation more accurately.

Name*

Address*

Phone*

Email*

What is your current occupation?*

What have you done in the past?

What is your current annual income, or the highest income you have achieved in the past?*

In what areas did you achieve your highest income?*

What are your 3 biggest challenges in your life, career, or business?*

What is your long-term vision/goal for your life, career, or business?*

What would be your top 3 desired outcomes of completing a mentoring program?*

If your life was perfect in 10 years, how would it be different from today?*

Are you currently in any mentoring programs, or have you previously been in one? If so, please explain and if applicable, tell us what you liked or didn't like about them.*

Chris Cumby

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