Coaching Services - Interest Form for UW Employees                                                  
Coaching for University of Wisconsin Employees Referral Program
Guidelines & Agreement

Thank you for your interest in the Coaching for UW Employees Referral Program. While the circumstances precipitating this offering are not ideal, we are nonetheless glad to coordinate professional services for our fellow UW-Madison colleagues during this time.

Before we provide a list of coaching service providers (via email), please read the following guidelines and complete the questions below.  

Note: your information is confidential and your interest in coaching will not be divulged to any entities.  

1. All coaching is pro-bono for a period of six (6) sessions (60 minutes each session) or 3 months, whichever comes first.

2. Each client will contract separately with their coach of choice to agree on date, times, duration of coaching calls, expectations, etc.

3. All coaching conversations are held in strict confidence, unless the client provides information that the coach determines may be endangering the life of the client or others. Further, no one will know that you are being coached (unless you tell them).

4. All coaching relationships will be conducted over the phone during this time, due to the risk of spread of the novel Coronavirus.

5. Coaches are not mandated reporters in the state of Wisconsin, but are ethically bound to report illegal activity, if learned through a coaching conversation.

6. The coaches participating in this pro-bono offering may count some or all of the Coaching hours involved in this effort toward their International Coach Federation (ICF) designations and credentials.

7. Coaching is not therapy, but rather provides an opportunity for self-discovery and personal growth with a focus on future goals and actions.

If you have any questions, please reach out to Michelle Galarowicz, Program Coordinator, UW-Madison Certified Professional Coaching (UWCPC) Program at

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First Name *
Last Name *
Preferred Email Address *
The Division of Continuing Studies and the University of Wisconsin - Madison are merely providing a referral source for interested clients. In consideration of the permission to participate in this offering of pro-bono coaching to UW Employees, I agree, for myself, my heirs, personal representatives or assigns, to hold harmless, identify, and release the Board of Regents of the University of Wisconsin system, its officers, employees, agents, from and against any and all claims, demands, actions, or causes of action of any sort on account of damage to personal property, or personal injury, or death which may result from my participation in the above-listed activity.  I understand that by agreeing to this clause I am releasing claims and giving up substantial rights, including my right to sue.   I have read and understand the Coaching Guidelines and agree to the terms of the referral program. *
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