Request a Mentor Form


Please fill out this form to request a mentor for Eagala Standard Mentoring. 
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Name
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Date
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Business name
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Address
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Phone
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Email
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Background
Tell us about your current Eagala work
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Month/year certified with Eagala
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Primary Eagala role
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Currently practicing Eagala Model work?
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If yes, number of Eagala session hours average per month
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Do you have an Eagala team partner? List name(s) if yes.
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Areas of Interest for Mentoring
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What specific Eagala Model mentoring guidance do you seek to receive?  Indicate any additional comments and priority under each one checked.
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Who else will be on the mentoring call? (yourself or list additional organizational team members)
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Additional Information
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What type of client population do you work with or hope to work with?
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Any time requirements - i.e. need a mentoring session by a certain date or time frame?
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Is there an Eagala approved mentor you would like to request?
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Any other needs or comments