Intake form

Name *

Email address *

What is your current level of education?

What specific goals do you hope to achieve through coaching?

What challenges are you currently facing in your academic or personal life?

How did you hear about the empowered scholar?

Please select at least one option.

Social Media

Friend/Family

Online Search

Event

Are you interested in online or in-person coaching sessions?

What is your preferred time for coaching sessions?

Which service or services are you interested in?

Please select at least one option.

Personal growth coaching

Goal-setting mastery

Emotional intelligence development

Confidence and communication skills

Initial consultation for $150

Follow-up consultation for $100

Additional questions or comments

The Empowered Scholar