High Performance Coaching Application
Please complete the following application to work with Eldin Hasa, Superior High Performance Strategist & Elite Success High Performance Coach
Full Name *
Phone number *
Mailing Address *
Occupation *
Date of Birth *
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/
DD
/
YYYY
Marital Status
Please briefly describe why you would like to be considered as a client of Eldin Hasa *
Please rate yourself in the following areas of your life on a scale of 1 (lowest) to 10 (highest).  CLARITY: Do you feel you are clear about who you are & the direction you want to go in life?
lowest
highest
Clear selection
ENERGY: Do you consistently have enough mental & physical energy needed to excel & accomplish your goals?
lowest
highest
Clear selection
MOTIVATION: How would you rate your level of motivation?
lowest
highest
Clear selection
HAPPINESS & FULFILMENT: How would you rate your levels of happiness & fulfilment?
lowest
highest
Clear selection
INTIMATE RELATIONSHIP : How would you rate your level of happiness in your intimate relationship?
lowest
highest
Clear selection
PRODUCTIVITY: Are you consistently focussed & effective? And are you good at minimising distractions?
lowest
highest
Clear selection
INFLUENCE: Do you feel you have the influence needed to accomplish your goals?
lowest
highest
Clear selection
PURPOSE: How purposeful do you feel in living each day?
lowest
highest
Clear selection
IMPACT: How satisfied are you with the impact you are making every day?
lowest
highest
Clear selection
NEGATIVE MENTAL REHEARSAL: Do you have something in the back of your mind that is bothering you, that you are trying to remember or forget, and intensity fluctuates. When you focus on this and the intercity is high, how high is it on scale 1 to 10? *
lowest
highest
What do you do for a living & why did you choose that career?
What are the top 3 goals you are striving to achieve right now?
What major stressors are you struggling with right now?
When you feel your most successful, what makes you feel that way?
What makes you happy?
Please describe your dream life
What has prevented you from having that dream life?
What goal or dream have you given up on or failed at? And what do you believe caused you to stop or fail?
What 3 big changes would you like to make in the next 12 months?
What are you most excited about in your life?
What negative, recurring thoughts, fears or behaviors would you like to overcome in order to feel more confident?
What health habits would you like to begin or break to feel stronger and more healthy physiologically?
What major projects or missions are you struggling to complete? What distracts you the most?
If you were more influential, what dream would you ask others to support you in achieving?
When & where do you struggle to be fully present?
How would you describe your purpose?
Why would you like to work with Eldin Hasa?
If accepted, why do you feel you would be an excellent coaching client?
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