Coaching Application Form

Coaching Application Form
Name

First NameLast Name
Email
example@example.com
What timezone are you in?
Work
Your role:
How many people are on your team?
Type "0" if you work solo
How productive do you typically feel at work?

1

2

3

4

5

1 is Very Unproductive, 5 is Extremely Productive
How would you rate your stress level?

1

2

3

4

5

1 is Zen, 5 is Very Stressful
Your work feels:

1

2

3

4

5

1 is Totally meaningless, 5 is Highly meaningful
Personal
At the end of a day, you typically feel:

Other
How much structure do you have in your typical day?
How many days a week do you do at least 20 minutes of uninterrupted, challenging exercise?
Which of the following practices do you do on a regular basis?

Other
Relationship
Your relationship status:

Other
If you're in a relationship, does it typically:

1

2

3

4

5

1 is Cost time and energy, 5 is Give you more energy
If you're single, dating / partner search:

1

2

3

4

5

1 is Takes up none of your time/energy, 5 is Take up a lot of your time/energy
Coaching Goals
What is the biggest obstacle you are facing, that you think coaching could help you with?
What, if anything, have you already tried to address this obstacle?
If we work together, what is your dream outcome? What would you life look like after 3-6 months?
To what extent are you ready and able to commit financially to a coaching relationship, in order to achieve your goals?

Other
Anything else you'd like to let me know?
Should be Empty:

Work