Thank you for your interest in the Potentializer Academy's programs. I look forward to meeting you so we can co-create what the best journey for you looks like. To begin our conversation, please fill out this application with as many details as you care to share, so that we can make the most of our time together. Your answers will remain confidential. I'm the only one to see them.
Where do you live?
{"type":"text","name":"__generic","width":50,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
Describe yourself in a few words.
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
If you had a magic wand, what would you do?
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
What is your definition of optimized human potential?
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
Have you ever worked with a coach? If so, how did it go?
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
What are you currently doing to optimize your time, energy and focus?
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
What's working really well for you in your life right now?
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
What is your greatest challenge right now?
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
What are your three top priorities right now?
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
What would change if you had the energy, concentration, and time you dreamed of?
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
Which of the below do you want help with now?
{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"Time management\nGetting more done more effectively\nWork-life balance\nGetting back on track with goals\nOvercoming overwhelm\nConquering distraction\nStopping procrastination\nHaving more energy\nTaming stress\nFinding balance\nBoosting focus\nDesigning habits and routines\nPurpose and values\nLeadership"}
On a scale of 1 to 5, how willing are you to invest financially in a coaching relationship over a mid- or long-term?
{"type":"radio","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"5 - Now is the right time\n4 - I'm thinking about it\n3 - Perhaps\n2 - I don't know\n1 - Not at all"}
Would you like to receive my email newsletter?
{"type":"radio","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Thanks for making your choice.","options":"I agree to receive a newsletter, information and offers from Anne Trager and the Potentializer Academy.\nI prefer to only receive essential communication."}
Thanks. Looking forward to the conversation.
Anne