Leader As Coach Application - Spring - Deep Coaching Institute

"*" indicates required fields

General Information

1. Name and Other Contact Information*

First Last

Job Title*

Company Name*

Cell Phone Number*

Email*

Name you prefer (if different from above)

2. Mailing Address (if needed to send course materials)

Street Address Address Line 2 City State ZIP Code

Professional and Educational Experience

3. How long have you worked at your current company?*

4. Briefly describe your role and responsibilities in your current work.*

5. Do you manage, or have you manged a team?*

Yes

No

6. How many years of management / leadership experience do you have?*

7. Please list your educational degree(s) (e.g. Undergraduate, Masters, Doctorate) and area(s) of study.*

8. What gives you the greatest sense of pride in your life and/or work? Why?*

9. What are your current challenges in life and/or work?*

Experience With a Coach and Coaching Skills Training

10. Have you ever worked with a coach? If Yes, what was your experience like?*

11. Have you ever received "coaching skills" training? If yes, what was your experience like?*

Personal Reflections

12. Do you have experience working with mindfulness or other contemplative practices (e.g. meditation)? If yes, please describe your experience.*

13. We find that every person participates in a leadership retreat in a slightly different way, by bringing unique gifts. How do you envision contributing to the group given your strengths and passions?*

14. Why is this program of interest to you at this time?*

15. What do you hope to gain from participating in the Building Coaching Presence for Leaders Retreat?*

16. If there is something we haven't asked that you feel is important for us to know about you, please let us know in the space below.

Leader-As-Coach Application Spring

General Information

Professional and Educational Experience

Experience With a Coach and Coaching Skills Training

Personal Reflections