The Changemakers Circle: 2018 Scholarship Application
Welcome!

Completing this application will take about 30 minutes. By filling out this application you are under no obligation to join The Changemakers Circle. This is simply an opportunity for us to connect and see if it's a right fit for you at this time. We welcome 12 seekers into this program each year and we look forward to receiving your submission. You will be contacted shortly after you submit this form to outline your next steps.

Privacy: everything you share is private and confidential. Please know it is a safe space to share openly and truthfully.

This program is designed to be a powerful investment in you, in your vision, and in honor of creating not just a 'successful' life - but one of deep fulfillment and meaning. Therefore, this program is an investment in your personal aspirations, in your work in the world, in your projects, in your relationships, and in your spirit. We will be creating change by looking at your life (w)holistically, through a 360 degree lense, exploring your personal, professional, and spiritual needs.

With this in mind, we want to support you in making sure this is the right decision for you. The more honest you are with your answers, the more we will be able to support you.

*Please visit my website to review all that this mentorship includes. http://www.ambercampion.com/thechangemakerscircle
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This application is for a 50% off scholarship and there are two payment options.

THE CHANGEMAKERS CIRCLE Scholarship:

A) single payment of $2,498
B) 10 monthly payments of $300

If it's fully aligned with you to join The Changemakers Circle this year, we will help you get there. The journey begins before the program even starts!


In Service to your Fulfillment,
Amber

Name (first, last) *
Your answer
Website(s) if applicable
Your answer
Email *
Your answer
Phone *
Your answer
Current mailing address *
Your answer
Birthday (Month/Day/Year) *
Your answer
How did you hear about The Changemakers Circle?
Your answer
Tell me a bit about your life and work in the world right now (in 10 sentences or less) *
Your answer
What are you challenged with or struggling with right now in your life and work? *
Your answer
What's going really well in your life right now? or something you are most excited about right now?
Your answer
What do you desire support with? (check all that apply) *
Required
Other
Your answer
In each category of life listed below, please tell me the most important way in which you'd like to grow in that area of life in the next year? So for example, for Vitality: health and fitness you might write - create a more healthy diet plan and for Balance: emotional life you might write - become more confident and less reactive. The first category is VITALITY: health + fitness *
Your answer
CREATIVITY: productivity + performance *
Your answer
PURPOSE: career/business + calling *
Your answer
CONNECTION: love + relationships *
Your answer
PRESENCE: spiritual life *
Your answer
INFLUENCE: leadership + impact
Your answer
INSPIRATION: intellectual life *
Your answer
BALANCE: emotional life *
Your answer
COMFORT: finances + lifestyle *
Your answer
Of the 9 categories below, which 3 do you currently feel are the most important for you to deepen into in right now? Please select only three. *
Required
Over the next year, what would you most like to improve in your life? *
Your answer
What is the single most thing you desire support with right now? *
Your answer
How committed are you to getting that result? *
Your answer
Have you worked with a coach or mentor before? If yes, what were you receiving support for and how was your experience? *
Your answer
I am committed to bringing together an extraordinary group of passionate, change-making minded, fulfillment seeking visionaries into this experience. Why do you feel this mentorship is right for you? *
Your answer
What do you feel you can contribute to support the growth and connection of this community? *
Your answer
Are you ready to make an investment in yourself? *
Your answer
There is just enough financial pressure that motivates us and allows for us to step up fully in the areas of our life we desire to do so. Would you feel comfortable making this investment without feeling EXCESSIVE financial or emotional pressure? NOTE: Please consider the GAINS from making this investment when you consider this question. *
Why are you applying for a scholarship? *
Your answer
What is your annual salary approximately? *
Your answer
Do you have any questions for me or want me to know anything else?
Your answer
If I am accepted for the mentorship and join, I am 100% committed to show up with integrity and do what it takes to make the most out of this life enhancing experience. *
If you selected 'no' or 'not sure,' please explain.
Your answer
Todays Date *
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