Request a Mentor Form


Please complete this form to request a mentor for Eagala Standard Mentoring. Standard mentoring is available to all who want to participate!  For those who are newly certified, two standard mentoring sessions are included in the cost of the Fundamentals training.  (Meaning, two (1 hour) session are offered at no cost to those who have become newly Eagala certified.) For those who do not qualify for the sessions through the Fundamentals training, the cost is $100/hour.

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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