Application Questions

Section 1: Basic Information

1. Full Name

2. Email

3. Phone

4. City/State

Section 2: Reason for Inquiry

5. Which Service are you applying for?

1-on-1 Life & Transformation Coaching

Developmental Mentoring

Group Mentoring Cohort

Not sure yet (seeking guidance)

6. What prompted you to seek coaching or mentoring at this time?

Section 3: Readiness & Responsibility

7. What area of your life are you most ready to take responsibility for changing or developing right now?

8. What does “growth” look like to you in this season? (Be specific — emotional, relational, personal, professional, etc.)

9. Are you willing to engage in reflection, apply insight between sessions, and participate actively in your growth process?

Yes

Somewhat

No

Section 4: Support & Scope (Important)

10. Are you currently working with a therapist, counselor, or other mental health professional?

Yes

No

If yes, optional: Please share briefly.

11. Are you currently experiencing a crisis that requires immediate emotional, psychological, or pastoral support?

Yes

No

Note: PKB Coaching & Mentoring does not provide crisis care, therapy, or pastoral counseling.

Section 5: Expectations & Alignment

12. What are you hoping this coaching or mentoring relationship will provide for you?

13. What would make this experience feel successful to you after 3–6 months?

14. How do you typically respond when challenged to reflect or consider a different perspective?

Section 6: Commitment & Investment

15. Coaching and mentoring require both time and financial commitment. Are you prepared to invest consistently if accepted?

Yes

I need more information

Not at this time

Section 7: Final Reflection

16. Is there anything else you would like me to know as I review your application?

Closing Statement (Place at End of Form)

Submission of this application does not guarantee acceptance.

All applications are reviewed for alignment, readiness, and appropriateness of fit.

If accepted, next steps and scheduling information will be shared via email.

Application

Application Process