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* 1. Name

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* 2. Email

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* 3. What is your age, living conditions, education, profession?  (if relevant please add your web address)

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* 4. What is your motivation for considering supervision with me?

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* 5. What is your biggest challenge at this moment?

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* 6. What would it cost you if you did not deal with this challenge (in your work, privately, physically, mentally or spiritually?)?

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* 7. What is your deepest desire right now? What would it bring you if you could fulfill that desire?

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* 8. On a scale of 1 - 10, how important is it to fulfill your desire?

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* 9. If we decided to work together, where would you want to be in +/- 5 months time? Why?

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* 10. On a scale from 1 - 10, how willing are you to invest time, money and energy in your personal and professional development?

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