Application Form - FOCOS Asia 2018
Information from this application will help the CMI Head Coach match you with the right coach. With your permission (see below) information may also be used for fundraising purposes. Please complete ALL requested information! When completed click the submit button at the bottom of the form. For more information and/or to send any additional items as email attachments, address them to: registration@cmiprograms.com
Contact Information
Full Name
Your answer
First Name
Your answer
Last Name/Family Name
Your answer
Mailing Address
Street Name
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City
Your answer
State/Province
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ZIP/PIN or Postal Code
Your answer
Country
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Location you are currently residing in (if different than above)
Your answer
Landline Phone #
Your answer
Cell/Mobile Phone #
Your answer
Email Address
Your answer
General Information
Marital Status
Family Information: (Spouse, Children, ages of children)
Your answer
Date of Birth
MM
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DD
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YYYY
Nationality
Your answer
First Language
Your answer
Ministry Information
Name of Sending Organization
Your answer
Years with organization
Your answer
Roles/Titles
List the major roles and/or titles you have in your work
Your answer
Personal Mission/Vision statement
(What is your vision? What are you called to do? How do you go about it?)
Your answer
How are you impacting the world now?
(Describe your roles and responsibilities)
Your answer
What do you hope for and feel is your destiny for the future?
Your answer
Describe your understanding of what coaching is and any coaching experiences you have had.
Your answer
Why do you want a coach? How can a coach help you fulfill your destiny?
Your answer
Coaching Information
Have you had previous formal coach training?
If yes, from what training organization did you receive your training?
Your answer
If you have previous formal coach training, please estimate how many hours of coaching you have provided to others since being trained as a coach.
Your answer
If you are already receiving coaching from a CMI coach, what is your coach's name?
Your answer
How many sessions have you completed with a CMI coach?
If you have already completed some sessions with a CMI coach, you will be given a discount of $17 per session (ex: Wolfi Jani provided three sessions to you, you still need 7. Your price is $105).
Your answer
Are you aware of a specific CMI coach that you wish to coach with?
(We will honor requests when possible)
If so, who?
Your answer
Your first 6 sessions you will be coached on a goal of your choosing. Are you looking for coaching in any of these speciality areas?
Required
Do you prefer?
Are you able to be coached in English?
If not, which language would be best for you?
Your answer
Is there any other information or a special need you wish for us to know about as we select a coach for you?
Your answer
Other Information
Are you able to commit to a year of training including the 6 sessions of personal coaching, the coach intensive onsite seminar, the 6 sessions of follow up mentor coaching, 30 sessions of practice coaching, and the 3 teleclasses ?
Are you able to pay the fee for your year of coach training?
Do you have access to a reliable broadband/highspeed internet connection?
In some countries, Internet traffic is monitored in such a way that individuals have concerns about language that is used in email communication, what websites they may be required to access, etc. Are you subject to these kind of security concerns?
Where did you first learn about CMI's FOCOS training?
Name of person who referred you (if applicable)
Your answer
Release
Do you give permission for this information along with your photo to be used for CMI fundraising purposes?
(This release gives us permission to share your data in print form, NOT ON THE INTERNET)
Name/Signature
Typing your name will serve as your signature in digital format.
Your answer
Date
MM
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YYYY
Submit
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