Student Application [Parent]

Instructions: Please Enter All The Required Details Below For Both Parent And Student. This Application Form Will Automatically Submit in 30 mins.

First And Last Name

Email:

Phone Number

Parent: Please state your occupation

Parent: Why would you like your child to be mentored by Dr. Hasnain?

Student: First and Last Name

Student: Email

Student: Age

Student: Current GPA, Desired GPA

Student: How do you define success? Don't overthink these questions. Write what comes to your mind in the first 10 seconds.

Student: Describe your current situation. What's not working? What are you struggling with?

Student: If you could wave a magic wand, what is your ideal situation? Your ideal self?

Student: What do you feel is your BIGGEST obstacle to achieving success? (Don't overthink)

Student: What have you tried before to make a change?

Student: On a scale of 1-10, how important is it for you to make a change?

Student: On a scale of 1-10, how confident do you feel about your ability to make the change without any help?

This is a paid course with limited seats available. Are you willing to show up, take action, and be committed towards improving your life?

Yes - I am 100% committed. I will take action. I will invest into my future. I will find a way to make this happen.

I am unsure at this point. I feel a little intimidated, yet with a proven system I would do it because I am serious about my future.

No - I am not willing to invest in my self . I’m going to stay exactly as I am. I will not actively build my future.

Student: LASTLY, why do you think you would be a better fit for this than somebody else from the group?

This Form Will Automatically Submit After 30 Mins