Guest Intake Form — IMPACT with Ceola J.

You Have Been Confirmed

Complete Your Intake Before We Record

This form helps Ceola prepare a personalized introduction and custom interview questions based on your story. Please complete every section as thoroughly as you can.

What happens next

Submit this form
Ceola will review your information and prepare your interview questions
You will receive your Interview Prep Package with proposed questions, your intro draft, and recording details
We record on the confirmed date and time via Zoom (audio only)

Questions? Contact Ceola at hello@theceolajcollective.com or call (925) 937-0600.

Guest Profile

Full Name (as you would like to be announced)

Preferred Pronouns (optional)

Title / Credentials

Organization / Ministry

Email Address

Phone Number (optional)

Website

Instagram / Facebook / Social Handle(s)

Your Bio

Professional Bio

Approximately 200–300 words. Ceola will use this to write your episode introduction and prepare your interview questions.

Interview Preparation

Are there specific topics or stories you really want to share during the episode?

This helps Ceola prioritize what matters most to you during the conversation.

Are there any topics you would prefer to avoid? (optional)

Media & Photos

Please share a Google Drive or Dropbox link containing your headshot and any additional photos. High-resolution images only (300 DPI minimum, no heavy filters).

Headshot Link (Google Drive or Dropbox)

Professional headshot, high resolution. Make sure the link is set to “Anyone with the link can view.”

Additional Photos Link (optional)

Lifestyle, branding, or action shots welcome (speaking, ministry, working, etc.).

Guest Appearance Agreement

Guest Appearance Release

By checking the box below, I grant permission to The Ceola J. Collective / IMPACT with Ceola J. Podcast and its successors, assignees, and licensees the irrevocable, perpetual, worldwide, royalty-free right to record, reproduce, distribute, modify, edit, display, perform, and otherwise use my name, likeness, voice, image, biographical information, and statements in connection with the IMPACT with Ceola J. Podcast.

This includes use on all media now known or hereafter devised: podcast audio platforms (Apple Podcasts, Spotify, etc.), YouTube, social media (Instagram, Facebook, etc.), the Producer's website, marketing materials, and promotional clips. The Producer shall be the sole owner of all rights, title, and interest in the recordings, including copyright. My participation is voluntary and no compensation will be provided.

I confirm that I have the full right and authority to enter into this agreement and that my statements will not violate the rights of any third party. I hereby release and hold harmless The Ceola J. Collective from any and all claims arising from use of my appearance. This agreement is governed by the laws of the State of California.

Submission of this form constitutes your digital signature and agreement to the terms above. A timestamped record of your submission is retained by Netlify Forms.