Gene Xcellence Success Coach Application

Success Coach Application

Please complete the form below to apply for to become a Success Coach. Please be aware that being a Success Coach is a volunteer opportunity that will require you to meet with student(s) at 3 to 6 times for their Individual Career Planning. Background checks will be required before becoming a Success Coach.
Full Name*

First NameMiddle NameLast Name
Email Address*
example@example.com
Phone Number*
Format: (000) 000-0000.
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date

MonthDayYear
How did you hear about us
If you picked "Referral," please list who referred you.

First NameLast Name
Available Start Date

MonthDayYear
Date
8th Grade9th-12 GradeYoung Adults (18-24)
Why do you want to become a Success Coach?
What advice would you give a student who is feels stressed at home and/or school?
For example, if a student says they have too many things to juggle right now. What is your response?
What advice would you give a student struggling with their sexuality?
For example, if a 14 year old student says they gay and is afraid to be open. What is your response?
What advice would you give a student that is on the verge of failing school?
What advice would you give a student that lacks confidence?
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