Application CPDC Student (2021)

Certified Professional Diversity Coach

Session 1, 2, 3 + Virtual Practicum

Tuition $7,997 + Application Fee $100 non-refundable

125 Training Hours Includes: Virtual Labs, Writing Assignment, Peer and Mentor Coaching

Upon acceptance into the program, your initial payment of $2,897 is due.
Training Program *

Certified Professional Diversity Coach
Select Location *

Virtual
Select Dates *

2021: Aug 25-27 + Oct 20-22 + Dec 8-10
Name *

Prefix First Name Last Name
Email *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone *

Area Code Phone Number
Gender *

Male Female
Which of the following best represents your race or ethnic heritage? *

White Black, Afro-Caribbean or African-American Latino or Hispanic Asian or Pacific Islander Middle Eastern or Arab Native American or Alaskan Native
Highest Level of Education Completed *
Which of the following best represents your religious affiliation? *

Buddhist Catholic Christian (non-specific) Hindu Jewish Mormon Muslim Protestant Sikh Non-Christian Faith None No Answer
Work History *

0/1000
Why Did You Choose CoachDiversity Institute? *

0/1000
Briefly tell us why you want to be a certified coach. *

0/1000
How do you rate yourself in the following areas:

Self-awareness *

	1	2	3	4	5

1 is Worst, 5 is Best

Active Listening *

	1	2	3	4	5

1 is Worst, 5 is Best

Emotional Intelligence *

	1	2	3	4	5

1 is Worst, 5 is Best

Being Non-judgmental *

	1	2	3	4	5

1 is Worst, 5 is Best

Openness to Learning New Things *

	1	2	3	4	5

1 is Worst, 5 is Best

How do you hope to grow through the program? *

0/1000
Describe your current professional and career goals *

I want to start my own coaching practice. I want to become an internal coach at an organization. I want to enhance my professional development. I want to use coaching skills in my therapy / counseling practice.
Who referred you? *

Application Fee $ 100.00

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