Mentor Assessment Application
Email address *
Date
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DD
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YYYY
First Name *
Your answer
Last Name *
Your answer
Phone *
Your answer
Email *
Your answer
Mailing Address *
Your answer
Age *
Your answer
What area of mentoring are you interested in (list as many that apply to you) *
Required
Why are you considering becoming a mentor? *
Your answer
What skills do you possess that would make you a good mentor? *
Your answer
Do you have any previous experience leading groups or mentoring others? Please give details. *
Your answer
What are your personal health goals? *
Your answer
On a scale of 1-10, how knowledgeable would you say you are in the Healthy by Design/WLGW Principles? What principles has most impacted your life *
Your answer
Describe your health journey? *
Your answer
Describe your faith journey? *
Your answer
What is your current weight? What is your desired weight? *
Your answer
What accomplishment are you most proud of in your life? *
Your answer
What weight loss programs have you taken in the past? *
Your answer
What country do you live in? Do you speak any other languages? *
Your answer
What timezone are you in? *
Your answer
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