Identity Restoration Mentorship Application

Please answer the following questions honestly and thoughtfully. This mentorship is designed for women ready to engage in personal responsibility, reflection, and intentional growth.

Completion of this application does not guarantee acceptance. Approved applicants will receive enrollment instructions.

SECTION 1: BASIC INFORMATION

First, Last name

Current season of life

SECTION 2: Readiness & Intent

Why are you seeking mentorship right now?

What feels most unsettled or unresolved for you currently?

What needs to change for you to move forward?

SECTION 3: Emotional & Identity Awareness

What emotional patterns or struggles do you find yourself repeating?

How do you currently view yourself—and how would you like that to change?

In what ways have past experiences shaped your identity?

SECTION 4: Commitment & Responsibility

Are you willing to engage fully in a 12-week process? Why or why not?

How do you respond when growth feels uncomfortable?

What does personal responsibility look like to you in this season?

SECTION 5: Faith & Alignment

How would you describe your current relationship with faith/spirituality?

Are you open to faith-centered guidance in this mentorship?

Yes

Somewhat

SECTION 6: Support & Screening

Are you currently receiving therapy/counseling or mental health support?

Yes

Are you currently in a mental health crisis or in need of immediate support?

Yes

If yes to either, please share briefly

SECTION 7: Final Reflection

What would make this mentorship successful for you?

Anything else I should know?

I understand this mentorship is not therapy or crisis care, and I am willing to engage honestly, responsibly, and consistently.”