Occupation: Employer: Job Title: Street Address: City
CONTACT INFORMATION Ms. Mrs. Name: Occupation: Employer: Job Title: Street Address: City, State, Zip: Email: How did you hear about this program?
Mr.
Dr.
Day Phone:
ABOUT YOUR COACHING Did you attend an Accredited Coach Training Program (ACTP) as certified by the ICF? Yes No If yes, what program did you attend? When did you complete the program? If no, please detail your coaching experience, training, and qualifications on a separate sheet. Are you an ICF credentialed coach? Yes No If yes, what level? ACC PCC MCC What other coach-related training have you completed? Education – please list degrees you’ve earned. Did you attend: 2016 Capital Coaches Conference SHORT ESSAY QUESTIONS On a separate sheet, please answer the following questions. • What about this program interests you? • What is your coaching philosophy and approach? • Tell us about any background you may have in strengths-based leadership, well-being, mindfulness, resilience, and adult development theory. • What will you bring to a cohort-learning environment?
Mr.
Dr.
Day Phone:
ABOUT YOUR COACHING Did you attend an Accredited Coach Training Program (ACTP) as certified by the ICF? Yes No If yes, what program did you attend? When did you complete the program? If no, please detail your coaching experience, training, and qualifications on a separate sheet. Are you an ICF credentialed coach? Yes No If yes, what level? ACC PCC MCC What other coach-related training have you completed? Education – please list degrees you’ve earned. Did you attend: 2016 Capital Coaches Conference SHORT ESSAY QUESTIONS On a separate sheet, please answer the following questions. • What about this program interests you? • What is your coaching philosophy and approach? • Tell us about any background you may have in strengths-based leadership, well-being, mindfulness, resilience, and adult development theory. • What will you bring to a cohort-learning environment?
