Mentoring Application

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Hi. My name is Derek Scruggs and this might be the most important form you ever fill out.

Why? Because I want to help you, and I have what it takes to help you overcome whatever is holding you back. At no cost to you.

For the last 17 years I've been founding and co-founding tech startups (such as StatsMix and SurveyGizmo), and for the last 10 I've been doing a lot of personal growth.

Lately I've found myself in the role of informal mentor to a number of people, and I've really liked that process. Now I'm pondering a career change to something like a coach or motivational speaker, but I'm not 100% sure that's what I want to do.

So I decided to offer up my mentoring services free of charge as a way to test whether I will actually like the work.

However, I can't do it alone. I will only work with people who are committed to taking action on their goals, not just talking about it.

Please take the time to really think about what you want to accomplish over the next 6-12 months, then fill out the form below. If it seems like a good fit and my schedule allows, I'll contact you for a 30-minute consultation where we can see if we both want to move forward. I wil commit to helping you in whatever way it takes to help you find and live your best life.

We will then design a plan together that will likely include the following: strengths assessment, goal setting, homework and periodic check-ins every few weeks to make sure we're both on the right track.

Are you game? Then what are you waiting for? Fill out the form below and I'll get back to you soon.
1. First, the basics. Please let me know your contact info.
2. What areas of your life do you feel need the most help? *This question is required.
  • * This question is required.