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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.)
Email address *
What is your first and last name? *
Your answer
Background: What would you like me to know about your life history, experiences, and core values?
Your answer
Goals: What would you like me to know about your personal, career, or family goals?
Your answer
Successes: What would you like me to know about the milestones you’ve already reached on the way to achieving your goals?
Your answer
Obstacles: What would you like me to know about the obstacles that have hindered your ability to achieve your goals?
Your answer
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?
Your answer
Thinking Process: What would you like me to know about how you like to learn, solve problems, or make decisions?
Your answer
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?
Your answer
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?
Your answer
Tell me about YOU: What makes you unique? Is there anything else you can tell me more about your values, interests, skills, style, etc.?
Your answer
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?
Your answer
Lessons Learned: Can you tell me about some of the lessons you have learned from your successes, and from your failures?
Your answer
Thank you!
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 leslie@thoughtsalive.com. Thanks! Leslie Householder
A copy of your responses will be emailed to the address you provided.
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