Soul Niche Breakthrough Secrets™
Confidential Application
This highly transformational programme is first and foremost an investment in yourself, your life and your business. The purpose of this application is to provide me with the necessary information needed to understand your present circumstances. This application allows me to see where you are in relation to this transformational experience. So, it’s very important that you be COMPLETELY honest in your answers.
As you complete this application form, you will have the opportunity to reflect on your past, current and future goals, this process will allow you to focus more specifically upon where you are and where you want to be in life, helping us to identify the challenges and bridge the gap. (many people have found this highly valuable and a hugely transformational experience in and of itself)
Rest assured that all of the information provided within this questionnaire is strictly confidential. Either print off, fill in, or scan, and email back to or add your answers in a different colour and email back. Once you have completed this application we will contact you to schedule a complimentary Discovery Session to ensure that you are suitable for the programme and that we are a good fit and discover which option best suits you needs.
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Name:
Business Name:
Street Address:
City:
State:
Zip Code:
Phone:
Cell Phone:
Fax:
Email:
Website:
About Yourself
If you could have three wishes right now that would make your career and lifestyle ideal, what would they be?:
Please describe yourself and your business as they stand right now (including how long you’ve been in business, your product/service or revenue streams, number of clients you serve, team size, list size and successes)
What are your biggest challenges in your business and your life right now? What are they costing you?
What are your three biggest accomplishments over the past three years?
Who or what do you think is responsible for your current results?
What is your financial goal for 2011?
What is your projected income for 2010?
What was your income for 2009?
Current income level
Less than 30K
30-50k
50-100k
100-150k
150-200k
1 million
1 million +
What have been your 3 biggest accomplishments in the last five years?
What is your short term vision for yourself and your company?
What is your long term vision for yourself and your company?
Who or what do you think is your biggest obstacle in you reaching your goals?
What motivates you?
Is there anything you would have to give up to reach your goals?
What self development programmes or mentoring have you previously invested in? (please describe)
What has it cost you or your business so far in not achieving your goals?
How committed are you to reaching your goals? (on a scale of 1-10, where 10 is totally committed, I’ll do whatever it takes)
Please rate on a scale of 1 to 10 (10 being the highest) your satisfaction
level in the following areas of your life.
a Business:
b Financial:
c Family:
d Health/Fitness:
e Spiritual:
f Recreation/Fun:
g Social:
h Personal Time:
i Mindset
At the end of our time together, what are the top 3 goals you want to feel elated at having achieved?
1
2
3
In 50 words or less, tell us why you should be selected for this exclusive programme.
© Kimberley Lovell 2011. All rights reserved.