Certification Pathway Application Form

Application Form

Fill out the form carefully to be considered for enrollment in the upcoming Western Integrity Coaching Academy Full Certification Pathway.
Student Name*

First NameMiddle Initial Last Name
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Mobile Number*
What draws you to mental performance coaching within western sports, and how do you see this training aligning with your personal or professional goals?*
What kind of coach do you aspire to become—and what impact do you hope to have on the athletes or communities you serve?*
This certification path requires a commitment to 10 hours of in-person volunteer coaching. Clients will be provided for you. Opportunities to coach professional athletes will be offered through a program with the Western Sports Foundation in which Western Integrity Coaching students will volunteer their time at events such as the Houston Livestock Show and Rodeo, PBR team events and more. This would be your responsibility to provide transportation, and lodging to fulfill this commitment. We work with you to facilitate the best fit based on location and timing. Is this something that you are able to commit to? Please feel free to explain your answer, if needed. *
The investment for this program is $5,000, plus processing. Please select the payment option that fits you the best. Payments made for the Module 1 workshop will be applied toward the full tuition.*

Single $5,000 payment$1,500 down and 3 monthly payments of $1,300
I understand that my application must be approved by the Western Integrity admissions team and this form does not guarantee my placement in the program.*

I understand
Signature*

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