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Private Mentorship Application Form

Thank you for your interest in Private Mentorship. This form is more of a self-leadership assessment therefore it isn't about proving yourself or answering perfectly. It's an opportunity for both of us to understand where you are today, what you're experiencing, and whether we're the right fit to work together.​ My work is designed for self-led women who are willing to understand themselves honestly, take responsibility for what they can influence, and consciously create the life they want to live.​ Take your time.

* My work is intentionally designed for self-led women because that is where my experience, perspective, and deepest understanding lie. If you're a man who resonates with this philosophy and feels genuinely called to work together, you're welcome to reach out. If I believe I'm the right person to support you, we'll explore the possibility together.

Clarity begins before our first conversation
About You
Birthday
Day
Month
Year
Why are you here?
Which areas of your life are being affected right now?
Looking beneath the surface.
If you had to describe the pattern that keeps repeating in your life, what would it be?
Self Leadership

This mentorship is built on the idea that meaningful change comes from awareness, responsibility, and conscious choice—not from blame or perfection.

Which statement feels most like you today?
I often wait for life to change before I do.
I know I have influence, but I struggle to act consistently.
I take responsibility for my life, even when it's uncomfortable.
I actively reflect, learn, and make conscious changes as I grow.
The Life You're Creating
Working Together
Are you open to receiving honest feedback that may challenge your current perspective?
Absolutely
Mostly
I'm unsure
Between sessions, are you willing to practise, reflect, and experiment with new ways of thinking and responding?
Yes
Maybe
No
Practicalities
Final Reflection

Before you submit this assessment, take a moment with this question.

Don't rush it.

Agreement

I understand that:

  • This mentorship is a collaborative process.

  • I am responsible for the choices I make and the actions I take.

  • Renita's role is to provide guidance, practical tools, honest reflection, and support—not to make decisions on my behalf.

  • Lasting change comes through awareness, application, and consistent practice.

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