Coaching Program Application
Thank you for applying to a clarity call with me where we will create an action plan to transform your life towards freedom, fulfillment and ease.

By answering the following questions (will take 5 minutes), this will help me understand you better and see if we would be a good fit to work together.

All the information is 100% confidential.

Please provide your full name *
Your answer
Please provide your phone number *
Your answer
Please provide your address (including Country) *
Your answer
Please provide your date of birth *
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Please provide your email address *
Your answer
What is the biggest challenge that is holding you back from going after what you really want? *
Your answer
When it comes to wanting to making a shift or change in your life, where do you want to start and why? *
Your answer
When it comes to getting clear about what it is you truly want, what excites you? *
Your answer
What would your life look like in 6 months from now if you made the shift you and your life felt easy and fulfilled? *
Your answer
Please rate the following areas of your life in relation to the satisfaction/ results you are achieving at the moment? 0 = no result, 7 = best result. PROFESSION - Your work and contribution to the world. *
no result
best result
BODY - Your health, wellness and fitness *
no result
best result
MIND - Your mind and any development, plus any skill building *
no result
best result
LOVE - Your partner, children, extended family & friends *
no result
best result
SOUL - Spirituality *
no result
best result
ABUNDANCE - Your wealth and finances *
no result
best result
SERVICE - Your community, cause, contribution, and tribe building *
no result
best result
Are you in a place where you are ready to commit to your growth in time, energy and financially? *
Your answer
Any additional comments *
Your answer
How did you hear about Samara? *
Your answer
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