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The Special Elite

VIP Mentorship

Program Application Form

Thank you for your interest in the Elite Mentorship Program. This program is designed for individuals ready to take massive action, elevate their life/business, and achieve extraordinary results. Please answer each question thoughtfully. Your responses help us determine if this program is the right fit for you.

Section 1: Personal & Professional Background

Last Name *

First Name *

Phone *

Email *

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)

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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

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

4d. Please provide a short answer to explain *

4e. How much time per week can you realistically dedicate to this program? *

3-5 Hours

5-10 Hours

10+ Hours

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:

Phone Call

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

We specialise in guiding everyday people to understand how to diversify and create an individual wealth strategy.

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