Ministry Leadership
Coaching Intake Form
Name
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First Name
Last Name
I'm interested in:
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Free Coaching
1 on 1 Leadership Coaching
Team Coaching
Fractional Executive Pastor
Email
*
example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date Of Birth
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-
Month
-
Day
Year
Date
Church or Organization Name
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If you serve at a church, what is the average weekly attendance?
Years at this organization?
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Position / Title
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Years in this position?
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Briefly describe your education background.
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What is your personal life mission / vision statement?
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Have you received coaching before? If so, what was your experience like?
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Are you willing to commit time and effort to implement the strategies we discuss?
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Yes
No
What is your biggest leadership challenge right now?
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What’s the #1 thing you’d like to improve in your ministry?
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What’s causing the most stress in your life?
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What areas do you feel you need to improve in the most?
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Who are the most significant people in your life and what do they provide for you?
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What are you doing on a regular basis that keeps you physically, mentally, emotionally and spiritually well?
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This is a good place to mention your hobbies, your exercise and devotional, routines, and anything else that keeps you going.
List up to 5 “time wasters,” excuses or ways you use to avoid hard things.
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What values and principles guide your decisions?
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Have you taken any personality assessments? i.e. Enneagram, Myers-Briggs, Strength finder, DISC, 360… Share those results.
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What encourages or motivates you?
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How will you know that you are receiving value from this coaching relationship?
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What else would you like me to know about you?
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Is there you'd like to know about me?
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Submit
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