Coaching Application - Impact, Inc.

Name

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Last

Your Contact Info.

Email

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Qualification Question 1: What brings you to want a coach now?

Qualification Question 2: What are the 3-5 main objectives you want to accomplish from the coaching relationship?

Qualification Question 3: Describe the kind of engagement you think you need. (i.e. What are you looking for from the expertise you want to hire?)

Please tick the check box next to your preferred coaching option below:

2 coaching sessions of 1/2 hour duration every two weeks or 1 session of 1 hour once/month.
2 sessions of 1 hour duration every two weeks or 1 session of 1 hour duration once per month.

** NOTE **

Special arrangements can be requested concerning payment(s). ** Upon completing this application, Renee Capone will invite you within 10 working days to a 45-minute telephone consultation to discuss your application and growth objectives in more detail. At the end of the phone consultation, should your application be accepted, both parties can make informed decisions as to whether to engage or not.