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Elite 1:1

Mentorship

Program Application Form

This space is for those who feel ready to move differently, to expand, refine, and elevate their life and business in a more aligned and intentional way. Please take a moment to answer each question honestly and thoughtfully. Your responses simply help ensure this is the right space for you.

Section 1: Personal & Professional Background

Last Name *

First Name *

Phone *

Email *

Identity (Female/Male) *

Social Media Profile (Instagram, Facebook, or LinkedIn) – kindly share at least one account you actively use *

1a. Current profession/business and primary source of income *

1b. What inspired you to join this mentorship program at this time? *

1c. What is your biggest personal or professional achievement so far? *

Section 2: Goals & Vision

2a. Top 3 goals for the next 12 months *

2b. Your vision for your life/business in 3–5 years *

2c. Why do you feel now is the right time to invest in yourself to reach these goals? *

Section 3: Challenges & Mindset

3a. What is your biggest challenge right now in achieving your goals? *

3b. How have you tried to overcome this challenge so far? *

3c. On a scale of 1–10, how committed are you to implementing strategies that push you out of your comfort zone? (1 = Not committed, 10 = Fully committed) *

On a scale of 1–10, how committed are you to implementing strategies that push you out of your comfort zone? (1 = Not committed, 10 = Fully committed)

3d. Describe a time when you overcame a significant obstacle. What did you learn from it? *

Section 4: Commitment & Investment

4a. Mentorship requires time, effort, and focus. Are you willing to fully commit to completing tasks and showing up consistently? Yes/No *

4b. Please provide a short answer to explain *

4c. Are you prepared to invest financially in your growth to receive guidance, support, and tools? (Yes/No) *

4d. Please provide a short answer to explain *

4e. How much time per week can you realistically dedicate to this program? (3-5, 5-10) *

4f. How do you typically handle feedback, criticism, or guidance? *

Section 5: Self-Reflection & Alignment

5a. What do you believe might hold you back from fully succeeding in this program? *

5b. What type of mentorship or coaching experience has worked for you in the past? *

5c. Why do you think this program is the right fit for you? *

5d. If selected, what would your ideal outcome look like by the end of the program? *

5e. Optional – If you had no fear or limitation, what would you attempt in your life/business right now?

One Final Step

Would you like to receive a proposal or next steps via: Email, Phone Call or Both? *

How Did You Hear About Us?

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Nyomi Holm

DIVERSIFICATION STRATEGIST

Guiding you to create a wealth strategy that feels aligned, sustainable, and supportive of the life you truly desire.

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