COACHING – it’s all about you! Anything is possible! Step 1 of 425%Personal InformationPlease provide your personal contact information.Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone* Home Phone Cell Phone Personal Email* Employment InformationPlease enter your work information.Company* Company Name Job Title Work Contact Work Email Work Phone Your Meeting & Contact PreferencesPlease let us know the best way to contact you, and how you would like to meet with your coach.Preferred Contact Method*Home PhoneCell PhonePersonal EmailWork PhoneWork EmailPlease select the best way for your coach to connect with you.Preferred Meeting Format* Phone Web ConferenceLet us know which meeting format works best for you. Getting to know youPlease answer the following questions based on your need for business or life coaching.What are you hoping to gain by working with a coach?*List 6 Goals or Challenges in your life right now:*What major changes have you been faced with over the last couple of years?*Where would you like to see yourself in 6 months?* Getting to know you - continuedLook forward twenty years…you are attending a function where someone is giving a speech about you, about what who you’ve been in your life, what you’ve brought to their life and the lives of others. What would you want them to say?*If time and resources were not a concern, describe the things you long to do.*Think about one or two people you know who really inspire you. What about them is inspiring? In what ways are you similar to these people*What can I say to you when you are ‘stuck’ that will return you to action?* ExpectationsPlease answer the following questions.How will you know when you are receiving value from the coaching process?*What else would you like me, as your coach, to know about you?*Consent* By selecting here, I understand and agree to the follow:I acknowledge that coaching is a comprehensive process that may involve different areas of my life, including work, finances, health, relationships, education, and recreation. By submitting this form, I agree that deciding how to handle these issues, incorporate coaching principles into those areas and implementing choices is exclusively my responsibility.CommentsThis field is for validation purposes and should be left unchanged.