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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
User Name:*
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 Select Your Coaching Areas*
Small Business Coaching

Please Select Your Areas of Expertise

Business Coaching - Owner or Managers of a small business Career Coaching
Executive Coaching - Professionals in private practice Leadership
Management Skills Mentoring for a New Coach
Communications Coaching / Public Speaking Skills Information technology
Business Startup/Entrepreneurs Coaching Business Teams
Financial Problems -- Business Life Coaching -Work/Life balance
Marketing/Sales Coaching Public Relations
Time Management - Getting Organized Other


Select your coaching areas*
Personal Coaching

Please Select Your Areas of Expertise

ADD Coaching Family Coaching
Eating Disorders Financial Problems -- Personal
Leadership Midlife Coaching
Personal Coaching Retirement Goal Setting
Time Management -- Goal Setting -- Getting Organized Coaching College Students
Coaching for Children - All ages Educational/Academic Coaching
Life Coaching Work/life balance Mentoring for a New Coach
Parenting Relationship Coaching - singles, couples
Spiritual Development Information Technology


Select your coaching area*
Corporate Coaching

Please Select Your Areas of Expertise

General Business Coaching Executive One-on-One Coaching
Financial Problems related to your Business Time Management (Goal Setting, Organization)
Time Management (Goal Setting, Organization) Strategic Planning & Shifting
Change & Transition Management Information Technology
Team Development & Assessment Leadership Development
Management Skills & Style Marketing & Sales Coaching
Communications Coaching / Public Speaking Skills Career Coaching
Customized Program / Other


Select your coaching area*
Career Coaching

Please Select Your Areas of Expertise

Business Coaching Career Transition - Career Change Evaluation
Educational/Academic Coaching Financial Problems -- Personal
Life Coaching - Life/work balance Marketing/Sales Coaching
Midlife Coaching Project Management
Retirement Goal Setting Time Management-Getting Organized
Board Member Coaching Business Teams
Executive Coaching Leadership
Management Mentoring for a New Coach
Communications Coaching / Public Speaking Skills Professional Development
Sales/marketing Web Page Design


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