Coaching Intake Form

Please complete prior to our first meeting.

Name

First Name

Last Name

Your Background

Tell me something about your personal background. For example: Where you live, or where you grew up, and a few other details to help me get to know more about you.

Your Work

Tell me something about your work background. What drew you to this industry? What is the most important thing about your work? What don’t you love about your day-to-day?

Your Challenge

Why did you apply for this program? What types of challenges do you face at work?

Wins

Tell me about a recent or standout win you've had in your career. Why is this meaningful to you?

Your Habits

How would others who interact with you describe your management and communication style? What habits/actions/thought processes do you believe need to be dropped or shifted to truly move forward?

Other Info

Is there anything else I should know that will help me help you over the next 6 months?

Confirm Commitment

Please read the following and confirm your commitment to our partnership. + I can be relied upon to be on time, prepared, and focused on all calls. + This is the right time for me to accept coaching. + I understand that it is my role to do the work necessary to get what I want in life. My coach’s role is to guide and support me. + I will follow through on the commitments I make. + I will give my coach the benefit of the doubt and "try on" new concepts or different ways of doing things. + I will speak straight (tell the whole truth) to my coach. + I am willing to feel uncomfortable feelings so that they do not sabotage my forward movement. + If I am not getting what I expect from my coach, I will ask for what I need. + I am willing to stop or change the self‑defeating behaviors which limit my success. + I see coaching as a worthwhile investment of my time and focus.