Life Coach and Counselor Application
The "Professional Guidance" Page I manage is for the benefit of my listeners and followers. They hold a place near and dear to my heart and all life coaches and counselors I establish a network with are an extension of my devotion to them. All information will be included on WithPolyAnna.com on the "Professional Guidance" page unless indicated otherwise. Inclusion on the page is not guaranteed to applicants. I do not charge a fee to include you on this page. I reserve the exclusive right to add or remove applicants from this page at any time. You can request to have your listing removed at any time. I follow up personally with each applicant(s) to review responses. Please fill out this form as completely as you can and within your level of comfort. Should you need to update your information at any time please contact me and I will send you the form for updates. This form is a living document and is subject to updates by me at any time. As you well know, potential clients are often in crisis or may be in an emotionally elevated state. It is important to me that your answers protect your time and space establishing reasonable boundaries for access to you. I am grateful to you for your generosity offering your skills and abilities to those in need of them. <3 Poly Anna
Full Name(s) and Business Name
Guidance Title
Clear selection
Contact Phone Number for Poly Anna (including area code)
Contact Phone Number for Potential Clients (including area code)
Contact Email for Poly Anna
Contact Email for Potential Clients
Biography (2-5 sentences)
Degrees/Certifications (include accrediting body)
Areas of Specialty
Are you available for remote counseling?
Clear selection
What is your remote counseling availability? (number of session limits, times, days, etc.)
What is your rate for remote counseling? (will NOT be published on "Professional Guidance Page)
Are you available for in-person counseling?
Clear selection
What is your in-person counseling availability? (number of session limits, times, days, etc.)
What is your rate for in-person counseling? (will NOT be published on "Professional Guidance Page)
What other services/products do you offer or want advertised?
Website
Social Media Links
What location(s) do you offer in-person counseling?
What are your biases?
What sex subcultures do you have experience working with?
What are your thoughts on ethical non-monogamy?
What are your thoughts on gay conversion therapy?
Describe your counseling methods/methodology?
What would you say is your personal philosophy as a counselor?
What is the meaning of life? (obviously 42, but beyond that)
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