2024 – Basirat Razaq-Shuaib

EXECUTIVE CONFIDANTE LEADERSHIP DEVELOPMENT APPLICATION

I understand

Thank you for your interest in the Executive Confidante Leadership Development service. This is a bespoke, confidential engagement for a select number of senior leaders, C-Suite executives and high profile individuals. There are limited spots and an application is required before your appointment can be scheduled. Please complete the form providing as much detail as possible. Your responses help me understand whether and how I can best support you. If the Executive Confidante service is considered suitable for your needs, you will be contacted with further information to book a convenient time for your appointment. During the appointment call, we will go through your needs in more detail, and I will explain how the executive confidante service works and what to expect. This call will take about 30 minutes.

Title *

Name *

First

Last

Email *

Phone Number *

Describe what you do for a living, or your primary responsibilities and interests if not currently working *

What specific challenges are you seeking support for? *

Have you sought any support in the past for these challenges? If yes, what was that experience like? *

Please share the top three things you hope to achieve from this service (This helps me understand your priorities and tailor the appointment accordingly) *

This service requires an investment starting at £10,000 for a six-month period. If you are offered a spot, are you ready, willing and able to invest in yourself? *

Yes
No
Maybe

If you selected Maybe or No, please provide a reason for your choice (Your response here helps me assess the best way to support you) *

Please provide any other information that you consider relevant

By submitting this form, *

You confirm that you are over 21 years old.
You provide your consent to receive future communications regarding this application and other upcoming events, services.

Year: 2024

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