Request Consideration

Executive Performance Advisory Application

Provide enough context for 360 Shift to determine whether a private conversation is appropriate. This is an initial qualification application, not a health assessment or enrollment form.

Approximately 7–9 minutesPrivate reviewNo obligation to proceed

What happens nextApplications are reviewed privately. When the need, timing, readiness, and advisory scope appear aligned, the applicant may be invited to a Discovery Call™. Submission creates no obligation for either side.

Protect sensitive informationDo not submit medical records, diagnoses, detailed health history, payment information, or other highly sensitive information here. Accepted applicants complete those requirements through the approved private enrollment system.

Section 01

Executive Information

Basic context for the initial qualification review.

Full Name *

Email *

Phone *

City / State

Current Title / Role *

Company / Organization

Section 02

Qualification

Six questions help us understand your current demands, primary constraint, desired outcome, and readiness to act.

1. Briefly describe your current role, responsibilities, and the demands you are carrying. *

2. Where are you experiencing the greatest constraint on your capacity or performance right now? *

3. How is that constraint affecting the way you work, lead, recover, or operate outside of work? *

4. What would meaningful improvement look like over the next 12 weeks? *

5. Why does this require your attention now? *

6. What are you prepared to change or protect in order to improve the structure supporting your performance? *

Section 03

Qualification Logistics

A few final details for timing and fit.

When would you be prepared to begin?

How did you learn about 360 Shift?

I understand that 360 Shift is a private, paid executive performance advisory engagement and that submitting this application does not guarantee a Discovery Call™ or acceptance.I understand that this public application is not the place to submit medical records, detailed health information, or payment information.

Private initial reviewNo payment collectedNo obligation to proceed