EFT Fast Track & ICM Mentoring Senior Mentors - Mentoring Program Intake Form

EMOTIONAL FREEDOM TECHNIQUES (EFT) FAST TRACK & ICM MENTORING PROGRAM

INTAKE FORM

Please fill in the form below so that your mentor can focus on what you want during mentoring sessions.

*mandatory field, please fill in.

First Name *
Last Name *

Date of Birth ( Please select the right format, eg 15-01-1976) *

E-mail to contact you *

Phone Number to contact you *

Current City for Time Zone *

Current Country *

Relationship Status *

Profession, for eg trainer, home maker *

Preferred Language for Sessions *

Other Languages for Sessions *

1. What are the goals you want to achieve during this mentoring program? *

2. Which areas do you want more focussed support?

Intake form analysis

Consultation calls

Sessions with clients

Preparing my case studies

Writing my case studies

3. How do you prefer to be mentored? (e.g., direct feedback, open-ended questions, practical suggestions, collaborative problem-solving, or constructive critiques) *

4. How do you prefer to receive feedback? (for example, straightforward and direct, softened with encouragement, through open-ended questions, or reserved with periodic check-ins) *

5. Any other information you would like to share with your mentor *

6. Senior EFT Fast Track & ICM Mentor you want to work with (read the instructions below):

You can share the names of your 3 preferred Senior EFT Fast Track & ICM Mentors you want to work with below. Here is the list of our Senior EFT Fast Track & ICM Mentors. We cannot guarantee that your first preference will be available, however we will do our best to get you connected or find you the best fit.

1st preference: *

2nd preference: *

3rd preference: *

Submission of this form means that you have read, understood and agree to these guidelines and terms.

In summary:

• Disclaimer: You agree to treat mentoring sessions as a form of professional or personal development and not as a replacement for medical or mental health treatment.

• Confidentiality: You and your mentor agree to keep the session(s) and any related information strictly confidential.

• Record Taking Consent: You agree that your mentoring sessions may be recorded (in the form of notes, audio, or video) and that these records will remain confidential and securely stored.

• Informed Consent: You provide informed consent for mentoring sessions, including discussions and practices that may involve EFT or other modalities.

• Data Information and Privacy: Your mentoring sessions and personal information are private and governed by our Privacy Policy and Data Protection Declaration.

• Indemnity: You agree to indemnify and hold harmless VLC from any acts or alleged acts by the Mentor.

• Dispute Resolution: You agree to indemnify and hold harmless VLC from any acts or alleged acts by the Mentor.

• Contact: If you have any questions about your mentoring session or the terms outlined above, please contact us at [email protected].

Yes I understand *

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