Request edit access
Confidential Application for VIP 1-1 coaching
To apply for a 1-1 coaching spot, please enter your name and primary email address and complete the application below.

I will contact you within 2 business days after I received your application form.

I personally review your application - no one else gets to see it.

You can either answer in English or Dutch.
Sign in to Google to save your progress. Learn more
What's your name? *
What's your best email address? *
Describe your current business + post the link to your website *
What is THE biggest struggle you face in your business right now? *
What would be the cost to you of NOT overcoming this struggle, and if you don't do something about it NOW?  (This cost can be emotional and/or spiritual and/or physical and/or or financial. How does this cost negatively impact your business, life, health, wealth, and relationships?) *
What's your true dream you have for your business? What do  you TRULY want to achieve and build? *
On a scale of 1-10, how much do you want to accomplish this business dream? Why? *
What coaching, training and/or services have you invested in over the last 3 years? Please describe *
If you and I decided to work together, what would be the main result or outcome you'd want to get in the next 3-6 months? Why? *
On a scale of 0-10, how ready are you to invest money, time, and energy in accomplishing your vision / dream for your business & life? Why? *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy