Mentoring Program Application

Download the PDF version here.


 " Individually we are a drop. Together we are an ocean"
                                     ~Ryunosuke Satoro 
Leading the way toward conscious change 

Jacqueline Barnett 

Mentoring Information

Welcome to the mentoring program application. I am very honored you are interested in the program and have a desire to create the life you desire. This program is for individuals who are looking for a support system and making changes from the inside out. 

Whether you are at a crossroad in your life or in a place where life is everything you want it to be, having a mentor can provide guidance when additional support is needed. 

"When you change the way you look at things, the things you look at change.." Dr. Wayne Dyer 

Format: This is a 6 month program. We will meet once a month for 6 months

What to expect from the program: 

  • Deepen your awareness of self limiting beliefs and perceptions and learn tools to envision new potentials and possibilities 
  • A safe and supportive environment with like minded individuals 
  • Guidance to help empower yourself to create a culture of inspiration and shared purpose that stands as a foundation for growth and success 
  • Basic tools for meditation to help you decrease stress and open up new levels of creativity 
  • Understand habits and how to consciously choose new and supportive ones 

Commitment: 6 Months. 

Investment: $999 paid in full or $200 per month for 6 months 

Mentoring Program

Name: ___________________________________________________ 

Address: ________________________________________________ 

City______________ State ________________________Zip______ 

Email: __________________________________ 

Home Phone: ____________________________ 

Cell Phone: ______________________________ 

Occupation: __________________________ DOB:_____________ 

Payment Option: Pay in Full_____ 6- $200 monthly payments______ 

Credit Card #_______________________ Exp_________ CRV_______ 

Signature: ___________________________ Date: ______________ 

Please submit your application to be considered for the program 

Return to: 

Pillars of Success, LLC 

Jacqueline Barnett 

7170 S Espana Way 

Centennial, CO 80016 

 Mentoring Program

Please complete your answers on a separate page and please include your questions with the answers. 

  • What inspires you? 
  • What do you love absolutely? 
  • What do you consider your greatest accomplishment in life? 
  • Do you have any regrets? 
  • What would be your purpose if you knew no one would judge you? If you knew you would not fail? 
  • If there were no limits to what you could have or could want in your life, what would that be? 
  • If you had all the money in the world, what would you do? 
  • Who has been your greatest mentor? 
  • What is your intention for living your greatness? 
  • If you had an opportunity to share your personal message with an audience of 1000 people before leaving this life, what would that one clear message be? 
  • How do you want to be remembered? Why are you here? 
  • How do you define happiness?