Verantia Advisory · Individual Mentoring

Intake Form

A short set of questions before we speak. It helps me understand what brought you here and come prepared to the call — it isn’t an application, and there’s no wrong way to answer.

Two of the questions below are optional. Answer everything else as fully or as briefly as you like.

  • Full name
  • Email
  • Phone number

01

What is the primary area you are looking for support with? — Career Growth · Personal Development · Performance Management · Leadership & People Management · Executive Presence & Sponsorship · Not sure / other

02

What’s happening right now that brought you here?

03

What would a good outcome look like in 3–6 months?

04

Current role / industry

05

Years of professional experience — 0–3 · 4–8 · 9–15 · 15+

06

Have you worked with a coach or mentor before?

07

How soon are you hoping to start? — Right away · Within a month · Just exploring

08 · optional

Tell us about a time you had to make a difficult decision at work, and what you learned from it.

09 · optional

How do you usually handle setbacks or things not going as planned?

10

How did you hear about this?

When you’re ready, send your answers by e-mail.

Send by e-mail
Opens a blank e-mail from your own address — no form, no database, no third party. Your answers are printed and filed; the message itself is deleted afterward.