Shannon Von Burns - Coaching Application
I am so delighted by your interest in working with me. I would love to meet you in person and get to know you and your goals better. I will get back to you with 24 business hours after you have completed your application.

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Full Name *
Email *
Country *
Age *
Occupation *
Job Title *
Gender *
Marital Status *
How do you feel about your current age? *
Please briefly describe how you have heard about my coaching services and why you would need a Strategy Session with me: *
Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? Please rate yourself: '1 = I have no clue' to '10 = I am totally clear' *
Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? Rate yourself: '1 = I am mentally and physically drained out' to '2 = I am fully energized, vitalized and charged.' *
Do you take action and consistently express who you truly are and what you truly think, need, and desire with the world? Rate your self: '1 = I am fearful, timid and weak' to '10 = Courage and fearlessness are my middle names.' *
Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? Rate yourself: '1 = I am all over the place, unfocused and day-dreaming' to '10 = I am attentive and am producing desired results.' *
Do you feel you have social influence with your family, friends, and team needed to accomplish your goals? Rate yourself: '1 = I feel powerless' to '10 = I have full authority, impact, and leverage.' *
What are your top three goals you must achieve in the next twelve months? *
Why must you achieve these goals now? *
What are the top three things that are holding you back? *
What are you most proud of and excited about in your life? *
What are the characteristics that you admire/respect most in yourself or others? *
What goal or dream have you ever given up on or failed at, and what do you believe caused you to stop or fail? *
What major stressors or challenges are you struggling with right now? *
What would your dream life look like if you could wave a wand and make it happen? *
Briefly describe your current state of health as it pertains to the following: Sleep, Digestion, Energy, Mood, Fitness level, Sexuality *
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