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Complete this application and click the "submit" button at the bottom when you are finished. A CoachLink representative will contact you and update you on the status of your application.

We will utilize the information you provide to create your online profile in our Trust Seal Member database. Complete this application and click the "submit" button at the bottom when you are finished.

General Information
First Name*
   MI
   Last Name*
  Gender* 
M   F
Company Name (if different)                        Federal ID # (if applicable)   
      
Business Address*
City*
   State*
   Zip*
Phone*
( ) 		    ext.   Fax
( ) 		  Mobile 
( ) 		 
Web site
E-Mail*
How did you hear about CoachLink?*

Education

Undergraduate Degree (University)
 Major

Completion Date
(MM/YY)

Graduate Degree (University)
 Major
 Completion Date
(MM/YY)
Formal Coach Training

  
Completion Date (MM/DD/YY)
Other Training & Dates:
Are you certified?
Yes   No
  From whom (ICF or other school)?
   Completion Date (MM/DD/YY)
Affiliations
   Previous Profession or Occupation*
Work Experience - Please provide us with the past 10 years of your work experience.
Company Address Company Phone Position Dates of Employment
 

Coaching Experience

Do you have a coach?*
Yes   No
  How long?
How did you get started in coaching?*
How many years have you earned money as a coach?*
Please select all industries you have worked in. (Use Ctrl key to select multiple industries or to deselect.)*
     Other:

Please describe your typical client? (Choose top 3) Use Ctrl Key to select multiple industries or to deselect)*

Average length of contract per client?*

   Comments:
What percentage of your time coaching a client is done over the phone?
How comfortable would you be using a phone as a medium for coaching?
 
Please indicate an acceptable fee range for your services* 
Less than $150 per month
$150-$250 per month
$250 - $500 per month
$500-$1000 per month
$1000+ per month
Other, please elaborate below about your fee structure 
   

Additional Information, Please give us a unique perspective on who you are.
Given what you know so far, what makes you interested in CoachLink?
What experience do you have coaching leaders?*
What are some of your favorite models / concepts / frameworks / principles that you use consistently in your work?*
Please tell us about some of your unique experiences and in life. For example important accomplishments, interests, and events.*
If you could change one thing about the world in this lifetime, what would it be?*
Who are your heroes and why?*
What is your favorite book?*
   What is your favorite movie?*
What are your hobbies?*  

Are you interested in participating as a speaker in one of CoachLink's seminars or workshops?
yes   No   Tell me more

References - Please list three client references. (Include 1 peer coach.)*
Name
   Company
Address
   Relationship to you
City
   State
   Zip
Phone
( ) 		    ext.
Name
   Company
Address
   Relationship to you
City
   State
   Zip
Phone
( ) 		    ext.
Name
   Company
Address
   Relationship to you
City
   State
   Zip
Phone
( ) 		    ext.
Name (Peer-Coach)
   Company
Address
   Relationship to you
City
   State
   Zip
Phone
( ) 		    ext.

By submitting the CoachLink Online Trust Seal Application, the undersigned agrees to all the terms and conditions of the Client Referral Agreement following:

Submit - Please check your application and click "submit" when it is complete.
* Required entry.

 

 

 


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