YOU ARE DESIGNED TO BE A SUCCESS Application Form If you are a human and are seeing this field, please leave it blank. WHAT’S YOUR STORY? Describe your three greatest accomplishments to date: What made these accomplishments stand out for you? What major transitions have you had in the past two years? (For example, new assignment, new residence, new relationship, etc.) If you worked with a coach or therapist before what worked well for you? If you have worked with a coach, and you are not currently, how did that relationship end? TELL ME ABOUT YOUR LIFE… Who are or have been your major role models? What attributes of these role models do you admire and want to emulate? What are the five most positive things in your life? What are the things you would like to change in your life that would make it even more satisfying, effective, and joyful? (Examples include relationships, information, environment, job.) Who are the key supportive people in your life, and what do they provide for you? On a scale of 1 to 10 (1 being least effective and 10 being most effective), rate the quality of your life. TELL ME ABOUT YOURSELF… List five adjectives that describe you at your best. What prevents you from being at your best? What brings you the most joy? What are you learning and accepting about yourself at present? Could coaching effectively resolve some issue in your life now? WHAT DO YOU REALLY WANT? What is your personal and/or professional vision? What would you like to contribute to the world? What are you most wanting to achieve in the next three years? What are you most wanting to achieve in the next six months? How ready are you to go for it? First Name Last Name Email
