Personal Information

Application Form

This application helps determine your eligibility and fit for the program while ensuring our call is as valuable as possible.

By answering these questions in advance, we can focus on meaningful insights during our session rather than spending the time gathering basic details.

My goal is for you to walk away from the call with clarity and a clear next step—whether we move forward together or not.

Please complete all required fields to apply.

Fields marked with * are required.

What’s your first name? *

Enter your first name.

What’s your last name? *

Enter your last name.

What’s your email? *

We will use this email to contact you.

What’s your timezone? *

Select your current time zone.

What’s your level of fluency in English? *

Fluent

Conversational

Basic

What do you do for a living? *

Do you enjoy your current career?

If not, what would you rather be doing?

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Application Questions

Please answer the following questions in detail.

Take your time, there are no wrong answers.

What phase of the Butterfly Path best describes where you are right now? *

Phase 1 (Survival Mode): I’m bracing and burned out

Phase 2 (Inward Reflection): I’ve retreated and want to heal using Islam

Phase 3 (Breaking Free): I’ve outgrown my old self but feel stuck

Phase 4 (Ready to Thrive): I crave presence, purpose, and alignment with my dream self

Which of the following do you struggle with the most? *

Click all the ones that apply.

What are you carrying right now that feels heavy, exhausting, or misaligned with how you want to live? *

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How would you describe your current relationship with Allah ﷻ? *

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Why does this matter to you now? *

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Have you sought help for this before — through coaching, therapy, self-development, secular healing, Western psychology or Islamic knowledge? *

If so, what did/didn’t work?

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What kind of support do you deeply crave that you haven’t found yet? *

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On a scale of 1-10, how willing are you to take action on what you learn in coaching? *

1 = not willing

10 = highly willing

Are you ready to commit to change and invest in personalized coaching within the next 14 days? *

Yes, I’m ready to invest my time, energy, and resources.

Maybe—I’m interested but need more clarity.

No, I’m not in a place to commit right now.

Is there anything else you want me to know before our call, insha Allah?

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