Coaching Application: Kelly Nerdzilla Mendenhall
The purpose of this form is to help you and me identify your primary interests in working with me, and whether I may be the right coach for you.
Email address *
Full Name *
Phone Number *
Why do you want coaching? What do you hope to get out of coaching? Be specific. *
What are you struggling with? (In your personal life and/or your professional life.) *
Have you ever hired a coach before? *
Did you have a favorable outcome? *
Please elaborate on past experiences with coaches. If you did not have a favorable outcome, explain why. If you had a favorable outcome, explain how. Give as many details as possible.
What are your goals for 2019 and 2020? These may be goals in your personal life or professional life. *
What is the number one obstacle that you believe is keeping you from achieving your goals? *
How committed are you to overcoming your obstacles and achieving your goals in 2019? *
Not Very Committed
Extremely Committed
How willing are you to do the work assigned and set out for you by your coach? *
Not Willing At All
Extremely Willing
How willing are you to be open and honest with your coach, regarding both your personal and professional life? (Note: This is a judgment-free zone, I am not here to judge you, but to encourage, motivate, and inspire you!) *
Not Willing At All
Extremely Willing
Please provide at least three days/times that would work well for a 30-minute compatability call. (There is no charge for this call.) *
Would you like to be added to my newsletter mailing list? You’ll receive things like inspirational thoughts for the day, updates on my writing projects, notification of new blog posts, public appearances and events, etc, *
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