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Application for Coaching
Please fill out the following application so that our team can evaluate whether you would be a good fit for our program. Completion of application does not guarantee acceptance.
Please fill out all information as accurately as possible. There is no minimum skill level to be accepted.
If your application is approved, a team member will follow up with you to schedule a phone interview.
This information is 100% confidential and is NOT shared with anyone.
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Full Name
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Your answer
City, Country
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Your answer
Mobile or Primary Phone Number
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Include area code
Your answer
Age
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Your answer
Email
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Your answer
Height (in Feet/Inches)
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Your answer
Weight (in pounds)
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Your answer
Ethnicity
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Your answer
Occupation
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Your answer
Link to Facebook Profile or Current Picture
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Copy and paste a link to a current picture of you or link to your facebook
Your answer
How many times in your life have you approached women you didn't know in order to start a conversation or get a date?
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e.g., in bars, clubs, parties, malls, etc
Your answer
Approx how many women do you approach or ask out (if any) each week?
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If none, write "none"
Your answer
Average Number of Dates You Go On Per Month
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If none, write "none"
Your answer
Number of (unpaid) Women You've Slept With
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Please be honest -- you can give an approximate if you'd like. If you're a virgin please say so. Your answers are strictly confidential.
Your answer
Number of committed relationships you've been in
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Please be honest. Your answers are strictly confidential.
Your answer
How long did your longest committed, sexual relationship last?
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Please be honest. Your answers are strictly confidential.
Your answer
Approx Skill Level
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Very socially awkward or stunted social skills. Find it hard to make friends or hold conversations.
Can make friends sometimes but often very shy in demeanor. Little to no experience with women or dating
Has friends and can even occasionally approach women and start conversations, but has high anxiety or runs out of things to say quickly
Talk to women regularly, but unable to keep the conversation going
Talk to women regularly and don't run out of things to say, but unable to generate any non-platonic interest from her
Women seem to be interested, but having a hard time getting more than the occasional date. High degree of flaking
Going on dates on a regular basis but not with the women you're really interested in.
Other:
Sticking Points
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Top 3 things/mistakes/problems holding you back right now from your ideal dating life
Your answer
What You Want to Get Out of Coaching
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Please be specific (not "I want to get better")
Your answer
What drew you to want to invest in coaching with us?
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Check all that apply
Company and/or instructor reputation
Tried everything else and nothing's working
The company's philosophies on growth and being attractive
Referred by someone (please specify on the last question)
Better value
Feel like DJ Fuji has a similar story or can identify with your story
The Long Term Coaching Program is the only one of its kind
Other:
Required
Why should you be accepted as a client?
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We receive many applications but only have a limited number of spots available due to the 1-on-1 nature of our coaching. Please tell us why you'd be a good fit for the program.
Your answer
Monthly Budget Range
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Our programs are almost all one-on-one mentorships where we work with you several times a month on an ongoing basis. Please select your monthly budget range so we can make an appropriate recommendation on training packages. Note that our personalized training packages start at $350/month
$100-$150/mo
$150-$350/mo
$350 - $450/mo
$450 - $600/mo
$600 - 1000/mo
Over $1000/mo
I can't afford monthly payments but I've saved up $2000 or more for a boot camp or live training event
I cannot afford any of these price points
Have you ever served in the U.S. military?
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No, I have not served
Yes, I have served in a foreign military
Yes, US Army/National Guard
Yes, US Navy
Yes, US Air Force
Yes, US Marine Corps
Other:
How did you hear about us?
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21 Convention / youtube speeches
Other youtube videos
Referred by a friend
Newspaper (The New York Times/Gothamist, etc)
TV Appearances (Dr. Phil, MTV, VH1, MYX TV, etc)
Book Appearances
Randomly googled
Met DJ Fuji or saw him speak live
Other:
If you were referred by a friend, what was his/her name or email? (so that we can send a thank you note)
Your answer
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