Coaching Evaluation

DATA COLLECTION / PROCESSING CONSENT* This field is required.Subject to the Data Privacy Act of 2012, all answers to this questionnaire shall be kept confidential and shall be used for invitation of service providers only. No personal information gained from this form shall be processed without your prior consent. Do you consent to register as "life buddy"?

YESNO

General Information* This field is required.

First Name

Last Name

Age

Please enter your phone

Gender

Address* This field is required.

Street Address

City

Country

Email* This field is required.

example@example.com

Current Work/Business/Course* This field is required.

Affiliate / Organization

Please specifyAffiliate / Organization

Do you currently serve as a mentor/ coach to others?* This field is required.

YESNO

How would you rate your mentoring skills on a scale of 1 to 5?

Holistic wellness programs that you can facilitate.* This field is required.Choose the top two categories

Emotional Wellness: Self Awareness & Self-Regulation

Mental Wellness: Stress Management, Anxiety, Fears, and Mindfulness

Physical Wellness: Diet and Workout

Spiritual Fitness: Prayer, Quiet or Devotional Time with God, Understanding the Gospel, Divine Principles & Law , Purpose and Calling, World View

Social Wellness: Trust and Connection

Life skill development programs that you can facilitate.* This field is required.Choose the top three categories

Budget Management

Cooking Skills

Clothing Skills

Cleanliness and Hygiene

Organization Skills

Communication Skills

Goal-Setting

Time Management

Decision-making Skills

Other

Please specifyLife skill development programs that you can facilitate

Professional skill development programs that you can facilitate.* This field is required.Choose the top two categories

Career Education

Communication

Critical thinking and problem solving

Teamwork and collaboration

Positive Attitude

Work Ethic

Leadership

Other

Please specify.Professional skill development programs that you can facilitate.

Hobbies & Interests* This field is required.

Other hobbies and interest not in the list Hobbies & Interests

Preferred gender you are comfortable to facilitate with* This field is required.

Male

Female

Both Male & Female

Available Day* This field is required.Select as many schedule as you want

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Available Time* This field is required.Select as many schedule as you want

8 A.M. - 11:00 A.M.

11:01 A.M. - 1:00 P.M.

1:01 P.M. - 4:00 P.M.

4:01 P.M. - 7:00 P.M.

7:01 P.M. - 10:00 P.M.

10:01 P.M. onwards

Preferred method of communication with the youth* This field is required.

Virtual

Physical

Hybrid (Virtual & Physical)

Please input your preferred locationPhysical & Hybrid

Age bracket you can accommodate

18 - 21 years old

22 - 25 years old

26 - 30 years old

31 - Above

Will you be willing to provide your services to a class or group setup?* This field is required.

YESNO

Are you also willing to offer your service for free in first 3 to 5 sessions?* This field is required.

YESNO

What is the maximum number of people you can accommodate?* This field is required.

Please provide your Facebook link so that we can add you to the facebook community group.

Is your service free of charge?* This field is required.

YESNO

Please provide a monetary value.

Terms and Conditions* This field is required.

Coaching Evaluation