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Personal Coaching with Leslie Householder Intake Application
Please review the following questions and thoughtfully respond as completely as you can. The more I learn about you and your objectives, the better I will be able to determine whether I will be a good fit for helping you achieve your goals at this time. (Acceptance into the program is also dependent on current space availability.)
What is your first and last name?
Background: What would you like me to know about your life history, experiences, and core values?
Goals: What would you like me to know about your personal, career, or family goals?
Successes: What would you like me to know about the milestones you’ve already reached on the way to achieving your goals?
Obstacles: What would you like me to know about the obstacles that have hindered your ability to achieve your goals?
Previous Study or Work: Have you worked with, or studied under, other teachers or mentors? If so, who? What were some of your key takeaways from each of these other mentors? What do you feel was missing for you in those relationships, if anything?
Thinking Process: What would you like me to know about how you like to learn, solve problems, or make decisions?
Natural Skills and Abilities: What are some things you feel you do best? What are some things that you want to do more of, or learn to do?
Have you completed the Mindset Mastery Program? If so, what were some of your key takeaways from that experience? What parts did you find easy? What parts did you find difficult? Why?
Tell me about YOU: What makes you unique? Is there anything else you can tell me more about your values, interests, skills, style, etc.?
Expectations: What do you hope to get out of a coaching relationship with me? Why do you want to mentor with me? What assistance do you hope I will provide?
Lessons Learned: Can you tell me about some of the lessons you have learned from your successes, and from your failures?
After I have received your responses, I will respond within 2 business days to discuss expected date of space availability, my assessment, and next steps. If you have any questions, you may send me a message to
. Thanks! Leslie Householder
A copy of your responses will be emailed to the address you provided.
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