Take Action Academy Application Form

Have you taken my Diagnostic Quiz? Have you taken my Diagnostic Quiz? YES (if yes, please proceed with this application) No (If no, please use the link below to take my free quiz)

What is your top diagnostic result? What is your top diagnostic result?Broke In TimeBroke In EnergyBroke In ConfidenceBroke In Follow-ThroughBroke In VisionBroke in Money/Value

Full Name

Email

City/Time Zone

LinkedIn/Website

Which of these best describes your current season of life? (select all that apply) Which of these best describes your current season of life? (select all that apply) Overwhelmed and stretched thin Clear about my goals but struggling to follow through Going through transition Building something new Trying to regain clarity and direction

What are you currently trying to move forward in your life?

What would meaningful progress look like for you over the next 3–6 months?

What kind of support do you feel you need most right now? (select all that apply) What kind of support do you feel you need most right now? (select all that apply) Accountability Structure and planning Clarity and decision-making Encouragement and community Strategy and guidance

Have you taken courses, coaching, or programs before? Have you taken courses, coaching, or programs before? Yes No

Why do you want to join the Take Action Academy?

Is there anything else you’d like me to know about your situation or goals?

How ready do you feel to implement and take action right now? How ready do you feel to implement and take action right now? I'm ready I'm ready, but I have a few more questions