Get Free - Services Interest Form

Hello! Thank you for your interest in Miakoda's Get Free services including coaching, workshops, consulting, trainings, and interim leadership.

Please complete the questions below. Then, schedule your free 45 minute consultation with Miakoda using the calendly link provided upon submission of this form.

If you have any questions, please contact geneva@jmiakodataylor.com

Email *
Date *
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YYYY
First Name *
Last Name *
Preferred Name/Nickname
Gender Pronoun (Ex: He/Him, She/Her, They/Them, Ze/Hir, etc.) *
Indigenous land you live on and the colonized name (city and state) *
Affiliated Organization and website (if applicable)
Title/Role (if applicable)
Phone Number *
At this number, can you receive (select all that apply): *
Required
How did you hear about Miakoda? (please note the specific source, i.e. name of individual, event attended, facebook page, newsletter, website, etc.) *
Anything about this moment that is motivating your interest in working with Miakoda and/or utilizing the Get Free services (in as much detail as possible)? *
What services are you interested in learning more about (check all that apply)
If coaching, please select the topics you are interested in (check all that apply)
If workshops, please select the topics you are interested in (check all that apply)
If trainings, please select the topics you are interested in (check all that apply)
If consulting and/or interim leadership, please write a short description of what challenges, opportunities and/or desired outcomes has you seeking our services:
During your call, Miakoda will share more about sliding scale and payment options, and partner with you to determine an appropriate reciprocity. In preparation for this discussion please share your understanding of the following:

What is your historical and current access to financial resources (personal or institutional)?

Are there any other factors that feel relevant to share that may impact the exchange of reciprocity for services you are interested in engaging?  
 *
Is there anything else you wish to share?
Do you have any questions for Miakoda?
Please list any access accommodations you may need for the initial online consultation call:
A copy of your responses will be emailed to .
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