This program is a high-level, one-to-one coaching experience designed for women who are ready to invest deeply in their growth and transformation. Completing this application is the first step in exploring whether this partnership is the right fit for your goals.

Please complete the form thoughtfully. Each question is designed to help us understand your challenges, aspirations, and readiness to step into this transformative journey.

Step 1: Personal Information

First Name *

Last Name *

Email *

Phone Number *

LinkedIn Profile

Personal Website

Time Zone *

Step 2: Your Goals and Vision

What are your top three goals for the next six months? *

What is your ultimate vision for your career, business, or life? *

If you could achieve one breakthrough during this coaching program, what would it be? *

What do you believe is currently holding you back from achieving these goals? *

Step 3: Visibility & Influence Challenges

What are the biggest challenges you face when it comes to speaking up, standing out, or being visible? *

How do these challenges affect your career, business, leadership, or personal growth? *

What opportunities or situations are you currently avoiding due to fear, doubt, or lack of confidence? *

What opportunities or situations are you currently interested in but need support and guidance with? *

Step 4: Commitment and Readiness

Why do you feel now is the right time to invest in your growth and transformation? *

This coaching program requires a significant commitment of time, energy, and focus. Are you prepared to prioritize your growth and do the work necessary to achieve your goals? *

What have you done in the past to invest in your personal or professional growth (e.g., coaching, mentorship, courses)? What were the outcomes? *

Step 5: Fit and Alignment

Why do you feel this program with Jani White is the right fit for you and what excites you most about the possibility of working together? *

What specific qualities or expertise are you seeking in a coach? *

Is there anything else you’d like Jani to know about you or your goals? *

Step 6: Practical Details

If selected, are you available to begin coaching within the next 30 days? *

How did you hear about the Empowered Impact - Exclusive Coaching Partnership? *

Friend/Colleague

Website

Facebook

Instagram

Other

If other, please specify here

Preferred Coaching Style *

Direct & Action-Oriented

Supportive & Encouraging

Highly Strategic & Performance-Focused

Accountability-Driven

Step 7: Next Steps

Once your application is reviewed, you will be contacted to schedule a call to explore whether this program is the right fit. Expect a response within 48-72 hours.