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The Change Agent
Cole Associates and Counselors of Texas
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First name
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Last name
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Current State You Live In
Email
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Phone
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Age
Occupation
What days and times are you available?
What are the three main areas you would like to be addressed in your one on one session?
What knowledge, tools and resources are you expecting to receive while in the program?
What are your top three strengths?
What are your top three areas of opportunities (weaknesses)?
Are there any potential barriers that may hinder you from completing the program?
Why did you choose this specific program Dr. Cole leads?
What are your expectations of Dr. Cole as your mentor during the three month program?
Payment Choices
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One Time Installment
$
650
Two Installments
$
450
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