Are you Coachable?

Name

First NameLast Name
Date

MonthDayYear
Date
Welcome to North Star International Life and Leadership Coaching! Are you ready to be coached? Do you want to change and grow? Are you willing to work with your coach in a collaborative relationship? Do you wonder how receptive you might be to coaching?

It's important to be open, accountable, and willing to persist in moving toward your goals in order to achieve great results. My goal is to help you reach your goals in the shortest time possible. Please rank the following statements.

I can be relied upon to be on time for all calls and appointments.

	1	2	3	4	5

1 is Disagree, 5 is Strongly Agree

I am willing to be accountable to another person.

	1	2	3	4	5

1 is Disagree, 5 is Strongly Agree

I am fully willing to do the work and let the coach do the coaching.

	1	2	3	4	5

1 is Disagree, 5 is Strongly Agree

I am willing to eliminate or modify any self-defeating behaviors that may limit my success.

	1	2	3	4	5

1 is Disagree, 5 is Strongly Agree

I am a self-starter and am willing to take the action necessary to achieve my goals.

	1	2	3	4	5

1 is Disagree, 5 is Strongly Agree

I will speak truth to the coach.

	1	2	3	4	5

1 is Disagree, 5 is Strongly Agree

I am willing to work with my coach in a partnership.

	1	2	3	4	5

1 is Disagree, 5 is Strongly Agree

I understand boundaries and actively set them in various areas of my life.

	1	2	3	4	5

1 is Disagree, 5 is Strongly Agree

I understand that coaching is not counseling, consulting, or mentoring.

	1	2	3	4	5

1 is Disagree, 5 is Strongly Agree

I am open to talking about my dreams, visions, and goals.

	1	2	3	4	5

1 is Disagree, 5 is Strongly Agree

I am not afraid to take risks.

	1	2	3	4	5

1 is Disagree, 5 is Strongly Agree

I am willing to consider new ideas, behaviors, and values.

	1	2	3	4	5

1 is Disagree, 5 is Strongly Agree

I have goals I want to achieve that have not yet been reached.

	1	2	3	4	5

1 is Disagree, 5 is Strongly Agree

Coaching is an ongoing partnership that will help me produce fulfilling results in my personal and professional lives.

	1	2	3	4	5

1 is Disagree, 5 is Strongly Agree

Laura Lawrence Wilcock, CPLC | www.northstarlifecoaching.com | laura@northstarlifecoaching.com | (203) 655-0800
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