Application For Mentorship Row concave Shape Decorative svg added to top Row concave Shape Decorative svg added to bottom Full Name Age Phone Number Email Address City & State What are you currently doing? SchoolWorkBothNeitherOther Briefly describe your current situation What made you interested in Manifest Change? What areas of your life are you looking to improve? DisciplineMindsetRelationshipsCareer directionConfidenceAccountabilityOther What challenges are you currently facing? What does change look like for you? What are 2–3 goals you want to work toward? Are you willing to commit to weekly sessions and honest conversations? YesNoUnsure Preferred days/times for sessions Is there anything else you’d like us to know? Please confirm: I understand this program requires commitment, honesty, and accountability.
