Full Name *

Phone *

Email *

Why NOW do you feel ready to go all in on you? *

What are you currently struggling with most when it comes to food, your body, or your mindset? *

How long have you been navigating these struggles? *

In what ways are these struggles impacting your life, health, or relationships? *

Please list below your previous diet history and which ones you found successful (if any): *

Weight watchers, jenny craig, low carb, keto, macro tracking etc

Describe your past history with binge, emotional, and or yoyo dieting: *

On a scale of 1-10, how would you rate your average level of stress (10 being high)? What are the main things that contribute to that stress? *

Do you have any routines, practices, or habits that help you manage stress right now? *

Such as yoga, reading, colouring, hot bath, gardening etc.

On a scale of 1–10, how ready are you to make meaningful changes in your life (10 being so ready)? Why did you choose that number? *

What has held you back in the past from making or maintaining change? *

Are you willing to be honest and vulnerable in this process, even when it feels uncomfortable? Why or why not?

What do you need most in a coach right now? *

Have you worked with a coach before? What worked/didn’t work about that experience? *

What does “support” look like to you when things get hard? *

If selected, are you able to commit to showing up for weekly calls, engaging in the team chat, and being an active participant for the full 6 months? *

What might get in the way of you fully committing to this opportunity? How would you navigate that? *

Why do you want this scholarship? What would it mean to you to be chosen? *

Where do you hope to be — mentally, emotionally, and physically — six months from now? *

Thank you so much for taking the time to share your heart and your story with me.
Your honesty and vulnerability are deeply valued, and I’m honoured that you’re considering walking this journey with me.

I’ll be reviewing each application with great care, and you can expect to hear from me by

Monday June 9.

No matter what happens next, let this moment be the line in the sand. The moment you stopped waiting for the “right time” and started showing up for the life you know you’re meant to live.
You are worthy of that kind of freedom and I hope you fight for it, whether we do it together or not.

With all the belief in you,
Sam xx