BIPOC Group Coaching Assessment
Answer a few questions to see if you meet the basic requirements.
Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
1. Where are you in your career?
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I'm a graduate student in a counseling and/or psychology program and have no clinical experience.
I'm a graduate student in a counseling/psychology program and have clinical experience.
I graduated from a counseling/psychology program and am waiting to complete my licensure requirements.
I graduated from a counseling/psychology program, am licensed, and have < 5 years of experience.
I graduated from a counseling/psychology program, am licensed, and have > 5 years of experience.
2. Which of these best describe your current situation?
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I can’t stop stressing about my lack of confidence in being genuinely myself with clients in general, or specific to white clients or ethnically/racially similar clients and worry that I’m not attracting ideal clients or retaining them. It bothers me a lot.
I have my good days and bad days. Nothing is urgent.
I’m actively working on my lack of confidence in being genuinely myself with clients in general, or specific to white clients or ethnically/racially similar clients and have support, such as therapy. I feel better than ever before!
3. What have you invested in to improve lack of confidence in being genuinely myself with clients in general, or specific to white clients or ethnically/racially similar clients? Who have you worked with? What have you done?
4a. In your own words, describe the outcome that you’re looking to achieve by investing in coaching with me.
4b. What do you feel is your biggest obstacle to improving your lack of confidence in being genuinely myself with clients in general, or specific to white clients or ethnically/racially similar clients?
4b. What do you feel is your biggest obstacle to improving your lack confidence and being your genuine self?
5. improving your lack of confidence in being genuinely myself with clients in general, or specific to white clients or ethnically/racially similar clients?
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less than $500
$500-1500
$1500-2000
There’s no limit; I have the resources to address this!
5. What is your readiness to solve this?
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I’m ready and able to commit now
I’m looking for a solution in 3-6 months
I’m just looking, not in a hurry, in a year
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