CE PROGRAM INTEREST FORM
Your Name *
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Title/Position *
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Institution/Organization *
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Office Phone Number *
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Mobile Phone Number *
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Email Address *
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How many years have you been a professional (not including grad school)? *
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How did you first learn about The CE Coaching/Educator Program? *
Your answer
What one aspect of coaching or education attracted you to the program? *
Your answer
What are three of the most important goals you'd like to achieve as a result of your experience? *
Personally, in relationships, and/or professionally?
Your answer
Why is it important for you to achieve these goals or make these changes? Why is this experience absolutely necessary? *
Your answer
For Professional Educator Certification, share a link to your 15-minute video here.
YouTube or Vimeo links accepted. Files can be emailed to info@collegiate-empowerment.org via www.wetransfer.com.
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What is your desired start date? *
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How would you like to get started? *
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Who is your preferred coach?
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The materials and concepts of The Collegiate Empowerment Program are presented to help you achieve personal and professional goals. CE will provide you with a system and structure to help you focus more effectively. This is not a substitute for the advice of your accountant, lawyer, doctor, mental health professional, and/or other advisers. All of your decisions and actions and their respective consequences, whether made in the context of this program or not, are entirely your own responsibility. As an active participant of The CE Coaching and/or Educator Program, you are licensed to reproduce the concepts, strategies and materials provided to you. The usage and distribution of these materials are limited to the members of your campus community. Any commercial use of the trademarks, concepts, methods, and materials of Collegiate Empowerment is prohibited without the specific written permission and licensing agreement from The Collegiate Empowerment Company, Inc. Collegiate Empowerment reserves the right to decline continued participation at any time during the course of the program. *
If you agree to these terms, type "I agree."
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