Deep Dive Mindshift Accelerator (or Mind Expansion Plus) Program Application
Mindshift Accelerator Goals Form for Complimentary Call
Thank you for your interest in the Bridgenosis® Mindshift Accelerator!
Organization (if applicable)
Position (if applicable)
Your Skype Name
This is so we have it for the mindshift session, if you move forward with it. We will call you by phone for the initial complimentary 15-30 minute consult. If you aren't sure, please look-up "Bridgenosis" and send a request to connect before your session.
Please check any that apply:
Other Leader or Professional
How did you learn about Bridgenosis? If by referral, please tell us who so we can thank them!
Are you interested in one or both of these programs?
Mind Expansion Plus
What are your top 3 goals for the Deep Dive Mindshift Accelerator Program?
What struggles or mental blocks are you currently aware of that are holding you back?
What is it costing you to NOT achieve your goals or remove your blocks? (time, money, relationships, business goals, family, health, happiness)
What have you already done to alleviate your struggles?
What are your best traits, strengths, and gifts?
Do you want us to send you a leadership development or stress reduction coaching proposal you can submit to your employer for reimbursement (or keep as a record if you are a business owner)?
Yes, my employer/business will likely reimburse it as leadership development/executive coaching.
Yes, my employer/business will likely reimburse it as stress reduction coaching.
Include an electronic invoice that my employer can pay Bridgenosis directly before we get started. (Electronic payment still needed.)
No, thanks. I don't need a proposal or separate invoice. I can signup online in your registration process.
Check all that apply.
Which of these are goals or obstacles you hope to reach or remove?
Increase confidence (overcome imposter syndrome)
Overcome public speaking fears, anxieties or nervousness
Increase focus & reach peak performance
Increase sales/investments/donors-be more confident when asking for money.
Quell your money and finance anxieties
Overcome anxiety and overwhelm
Scaling with confidence
Hire, retain, and delegate with confidence
Preventing & unraveling conflict or tension in a relationship or your organization
Make time for yourself while still performing your best.
Stay centered when encountering negative people
Stop ruminating over the past; overcome shame/blame; move forward; be present
Overcome fear of letting others down if not win or qualify big
Overcome fear of failure
Overcome over-empathy & say no guilt-free when boundaries are needed.
Cravings or weight issues
Chronic stress showing up as pain
Trauma and/or PTSD
What's your time zone?
When are the best times to reach you in the next week or two for a short interview to ensure the Deep or Deeper Dive Mindshift Accelerator is the best match for you.
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