Application Form

To make our 60 minute Heart to Heart Chat together as valuable as possible, please fill out the application thoroughly and honestly. Thank you.

First Name*

Last Name*

Email Address*

Street Address*

City*

State*

Country*

Telephone*

How did you hear about Nicole Justine?*

Why are you interested in working with Nicole Justine Reid? There are a lot of coaches available out there. What makes you think Nicole Justine is the right coach for you?*

In what ways do you feel you are not fully living up to your potential?*

What would unleashing your potential look like for you?*

Why now?*

If you sense you have a mission or a purpose here on earth, what might it be?*

What else have you been doing to support yourself on your spiritual path?*

Describe your current relationship with God/Source/Universal Energy/your name for this higher power is.*

What are your biggest challenges to fulfilling your potential? What support do you need?*

On a scale from 1 to 10 (10 being highest), how important is it for you to unleash your potential and expand into all of who you are as a spiritual being and earthly being?*

On a scale from 1 to 10 (10 being highest), how ready are you to invest time, energy, and money into unleashing your potential?*

On a scale from 1 to 10 (10 being highest), how ready and committed are you for transformation now?*