Welcome.

Thank you so much for your interest in the 6-month group coaching program.

Please answer the questions below, so I can gain a well-rounded understanding of who you are, and what you're looking for and to ensure the program is a fit for you.

But before you fill out the form, please make you sure you've carefully read the information on the From The Core page.

Thank you & I look forward to speaking to you soon.
‍
All the best,
Jord

1. Personal information

First Name:*

Last Name:*

Email:*

Phone:*

Instagram

How did you hear about me?

2. Background

Please tell me about yourself - Where are you from? Your age? The nature of your work or business?*

3. Current circumstances

Why do you believe now is the right moment for mentorship in your life/career?*

What are the top three most present challenges you're currently facing?*

4. Purpose of mentorship

What key outcomes/experiences do you hope to achieve through this mentorship?*

5. Commitment

On a scale of 1-10, how important is this matter to you? Please explain why you’re ready to commit to yourself and this process. *

The investment for this program is $ 4,500 USD. Are you in a position to invest in yourself at this level? *

YESNo

If this program is right for you, are you able and willing to attend the weekly calls? *

YESNo

If this program is right for you, are you willing to participate in group work? *

YESNo

4. Questions and/or thoughts

Is there anything else you want me to know before the call? Any questions or thoughts are welcome.

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.

Follow me on Instagram

@Jordcuiper

Freedom to

live how you want.

Confidence to

own your story.

Strength to

give what it takes.

Join the growing list of leaders in my bi-weekly newsletter. Sign up today and get immediate access to three of my highly requested guides for redefining success, growth, and purpose.

Group Coaching

Sign Up

Welcome.

1. Personal information

2. Background

3. Current circumstances

4. Purpose of mentorship

5. Commitment

4. Questions and/or thoughts

Follow me on Instagram

Freedom to

live how you want.

Confidence to

own your story.

Strength to

give what it takes.