MindStory Academy

APPLICATION for The MindStory Certification Program

First Name*
First
Last Name*
Last
Email*
Best "Contact" Phone Number
Call Preference*
- Phone
- Skype or Zoom with Video
- Skype or Zoom Audio Only
Time Zone*
Best Phone Number for Strategy Call OR Skype ID*
Link to Facebook Personal Page*
Link to Facebook Business Page*
Link to Twitter Account*
Link to LinkedIn Account*
(Optional) Links to other social media accounts, Instagram, Pinterest, additional Twitter accounts, etc.
How did you hear about Carla Rieger, Dave O'Connor or MindStory Academy? (Check All That Apply)*
- On email list
- Search Engine
- Advertisement
- Referred by a Friend / Colleague
- Heard about it on Podcast or Webinar
- Other
If referred, who do we thank?
Tell us briefly about your business or role in life right now*
What market do you serve? I.E. Who is your customer, company, or who do you want to serve?*
If you have a business, how much do you charge for your products and services?*
What makes you different from your competitors?*
Why do you want to train as a MindStory Performance Coach?*
What skills, experience, interests, resources or habits do you have in place now that will help you be successful in this training and beyond?*
Are you willing to fully commit to the training and give it your absolute best?*
- Yes
- No
- I'll try
What currency do you mostly earn your income in?*
- US Dollars
- British Pounds
- Euros
- Canadian Dollars
- Australian Dollars
- Other - please specify
What is your general yearly income from all sources?*
- Less than 10K per year
- 11K to 50K per year
- 51K to 80K per year
- 81K to 100K per year
- 101K to 200K per year
- 201K to 500K per year
- 501K to 999K per year
- More than 1 million per year
What is your target yearly revenue 2 years from now?*
Be totally open with your answer. . . what do you think is stopping you from hitting the number just above right now? . . . The more specific you are here the better.*
If we decide to work together so that you can be a certified coach, and help you reach your goals above, what would success look like to you?*
- I would be coaching people in my own existing business
- I would be coaching people as part of a new business I'd like to start
- I would be using the coach training in an existing job I have now
- I would be using the coach certification to help me get a job in a company
- Other
If we both feel it's a good fit for you to participate, do you have the financial resources to fund your participation in the coach certification program?*
- Yes
- No
- I'm not sure. I need to research funding sources.

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