Love Wins Program Interview Form

Personal Information

Full Name:

Email Address:

Phone Number:

City, State, Country:

Preferred Contact Method:

Phone

Email

Text

Your Journey & Goals

What inspired you to explore the Love Wins program?

What areas of your life do you feel most challenged by right now?

Self-Worth & Confidence

Healing from Past Trauma

Spiritual Growth

Finding Life Purpose

Relationship Challenges

Other:

What specific results or breakthroughs do you hope to achieve through this program?

How committed are you to investing time and energy into your personal transformation?

100% Committed

Somewhat Committed

Still Unsure

Have you participated in any other coaching or self-development programs before? If so, what were your experiences?

Spiritual Alignment

How would you describe your current spiritual beliefs and practices?

Deeply Connected

Exploring

Unsure

Seeking Guidance

What role does faith or divine guidance play in your life?

Are you open to faith-based coaching and spiritual transformation?

Yes

No

Unsure

Commitment & Readiness

Are you prepared to dedicate time each week for coaching sessions, self-work, and personal reflection?

Yes, I am fully ready

I want to, but I have some concerns

Not at this time

Do you have any hesitations about joining the program? If so, what are they?

Are you looking for professional help that would be better suited to a doctor or psychiatric counselor? (If yes, we kindly recommend seeking professional medical or mental health support first.)

Yes

No

Next Steps

Once you submit your application, we will review your responses. We will then determine if this program is the right fit for you. If you qualify, we will reach out with the next steps to begin your transformation!

By submitting this form, you confirm that you are ready to explore this opportunity with an open heart and mind.