Full Name

First Name

Last Name

Email

Phone Number

Where are you located?

City & Country

What called you to apply for The Rebellion Mentorship?

What about this mentorship feels aligned for you right now?

What is the biggest challenge(s) or obstacle(s) you’re currently facing?

Where are you feeling stuck in life, work, or relationships?

⁠What are your main goals for working together?

⁠How would you like me to support you most during this mentorship?

eg. structure & accountability, deep inner work, embodiment practices, mindset coaching

Are you willing to invest in yourself and ready to start?

eg. time, energy, and financial commitment

application form

THE REBELLION MENTORSHIP