New Girl On The Block Mentorship Application Form
Thank you for your interest in this mentorship program. This application is intended as a means of informing and gaining your consent to be a willing participant in the New Girl On The Block Mentorship Program.
Start
 
What is your first name? *

 
Hi {{answer_12747757}},

Thank you for your interest in the New Girl On The Block Mentorship program!

This application is intended as a means of informing and gaining your consent to be a willing participant in the New Girl On The Block Mentorship Program.   After receiving this completed application from you, Pauleanna will evaluate the information in preparation for a free 15 minute consultation via phone

Let's get started!

 
About You 

 
What is your last name? *

 
Which city do you live in? *

 
What is your province or state? *

 
What is your street address? *

 
What is your email address? *

 
What is your telephone number? *

 
What is your age range? *


 
Gender *


 
What is your ethnicity?


 
You Are (Choose all that apply) *


 
Highest Level of Education *


 
If you are employed, what level of employment have you achieved?


 
Martial Status


 
Do you have a child or children?


 
Let's customize your mentorship

 
{{answer_12747757}}, what are you seeking mentorship for? *






 
What type of mentorship are you looking for? *


 
How often would you like to meet? *


 
Through which format would you prefer to meet? *


 
Why are you seeking a mentor at this time? Give a brief overview of where you are at in your life right now? *

 
What obstacles are you experiencing? *

 
Describe your expectations for this mentorship?
*

 
Please select your mentor. Selection should be based on your specific needs, not location. Skype/email sessions are also available. *


 
Capture your Vision for your Life

 
Describe yourself in a few short sentences:
*

 
Describe the type of woman you want to be (life, career, love, etc.)
*

 
List 3 areas that you need to improve on:
*

 
What short term (1 year) goals/objectives have you set for yourself in life, career and love?
*

 
What long term (5 year+) goals/objectives have you set for yourself in life, career and love?
*

 
Who do you admire in life, career and in love (can be someone you know, celebrity, public figure, etc)?  Please describe why.
*

 
Construct Your Personal Brand

 
What is your Twitter Handle?

 
What is your Facebook profile?

 
What is your instagram account?

 
What is your Pinterest account

 
What is your Linkedin account

 
Your brand identity checklist: *

(check all that you currently have)

 
Which of the above areas do you need to improve / get started on? *

 
What brands / businesses / business personalities inspire you? Why? *

 
What are you great at? Take this time to brag about your skills and unique abilities. *

 
Develop Your Personal Style

Complete this section if you are interesting in Styling sessions
 
{{answer_12747757}}, when you enter a social setting, do you feel comfortable working the room or do you avoid attention?

 
What is the best compliment someone can give you?

 
What is something amazing about you that no one knows?

 
What single experience has transformed you and why?

 
On a scale of 1-10, how high is your level of confidence?

 
How would you describe your current image and personal style?


 
What would you like to achieve during this wardrobe planning appointment?

 
Who are your top 3 style influences?

 
Last question {{answer_12747757}}! Do you have extra information, comments or requests you would like us to consider? *

 
Much of the information you supply in this application will be used to prepare a custom program for you. All information is held confidential and will not be shared with any third party. Pauleanna Reid’s business team is also bound by confidentiality as it pertains to any and all information relating to Pauleanna Reid programs and events.

 
Please review the following and enter your full name if you comply. *

* I give my informed consent to be a willing participant in the New Girl On The Block Mentorship Program and its related activities.

* I agree to follow all mentoring program guidelines and I understand that any violation on my part can have a direct effect on the outcome and my expectations of the program.

* I release Pauleanna Reid of all liability of injury, death, or other damages to me, my child/children, family, estate, heirs, or assigns that may result from my participation in the program, including but not limited to transportation, and hold harmless any of Pauleanna Reid’s business team or other representatives, both collectively and individually, of any injury, physical or emotional, other than where gross negligence has been determined.   I understand I must submit this completed application, and that any incomplete information will result in the delay of my application being processed
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