Impact Academy Application for Admission
Confidential Application for Enrollment into The Impact Academy
Full Name *
Your answer
Email Address *
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Company Name
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Website
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Which of the below profiles fits you best, based on the current level of business you want to grow? *
Describe your business (or career) right now: products, programs & services. *
Your answer
What are you currently doing to market your business? Please include the current size of your email list. *
Your answer
List the 3 biggest obstacles you feel you need the support and power of an Expert Mentor and Peer Group to work through this coming year. Please list the most pressing issue first. *
Your answer
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List your top 3 business goals for the upcoming year. *
Goal 1
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Goal 2 *
Your answer
Goal 3 *
Your answer
If you could change 3 things in your business or life by waving a "magic wand" what would that be? *
Your answer
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Your answer
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Your answer
How ready and WILLING are you to invest in yourself and your business right now to take more decisive-guided action in order to achieve the results you desire? (Factor in dedication, time and financial resources) *
Your answer
Why do you feel a program like this is right for you and what you need at this time? Why is it important for YOU to be accepted? *
Your answer
Confidential Data: Income From Your Business Only - Gross business income (estimated) for 2015? *
Your answer
Gross income from your business in 2014? *
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Your Phone Number? *
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Your Mobile Phone Number? *
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Your Zip Code? *
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Thank you for taking the time for yourself/your business to submit this application. Please use this space to include anything else you might want to share with us.
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