Life & Leadership Coach Training Application 2017
To apply for the Life & Leadership Coach Training provided through CMI, please fill out the following information. The information provided will be used to determine eligibility for participation in this program and will only be used for screening and administrative purposes.
Contact Information
First Name
Your answer
Last Name
Your answer
Mailing Address or PO Box
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City
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State/Province
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ZIP/PIN or Postal Code
Your answer
Country
Your answer
Residence (City, State, Country - if different from above)
Your answer
Telephone - Landline
Your answer
Telephone - Cell
Your answer
Skype ID
Your answer
Preferred Email
Your answer
Personal Information
Marital Status
Family Information: (Spouse, Children, ages of children)
Your answer
Date of Birth (DD/MM/YYYY)
Your answer
Nationality
Your answer
Organizational Affiliation
Organizational Affiliation (Current)
Your answer
Titles/Roles within Organization
List the major roles and/or titles you have in your work
Your answer
How many years with Organization?
Your answer
Past organizational affiliations
Your answer
Coaching
What is your understanding of coaching? What has been your personal experience with coaching-- receiving and/or providing it to others? (Include any previous coach training)
Your answer
Briefly describe why you want the LLCT. How do you see yourself using coaching, both in the near- and long-term?
Your answer
Ministry Experience
Briefly describe any experience in ministry, including total number of years.
Your answer
Briefly describe your experience with developing others in their gifts and callings.
Your answer
Skills
List languages spoken in order of fluency. Please note with an asterisk (*) those you could use for coaching.
Your answer
Check any of these Assessment Tools you have taken.
Check any of these Assessment Tools you are qualified to administer.
Do you have counseling qualifications?
If yes, briefly describe degrees, certifications, and/or experience.
Your answer
Other relevant skills:
Your answer
Check all of the following that apply to you
Checking or not checking any of the following will neither automatically qualify nor disqualify your acceptance into this program.
Required
Confidential References
Please provide full names, emails and telephone contact info for the following
Pastor or Organizational Leader: Name
Your answer
Pastor or Organizational Leader: Email
Your answer
Pastor or Organizational Leader: Telephone No.
Your answer
Co-worker: Name
Your answer
Co-worker: Email
Your answer
Co-worker: Telephone No.
Your answer
Non-family person who knows you well: Name
Your answer
Non-family person who knows you well: Email
Your answer
Non-family person who knows you well: Telephone No.
Your answer
I first learned about CMI's Life & Leadership Coach Training through
(check all that apply)
Required
Person who referred you (if applicable)
Your answer
For Program Transfer Applicants Only
I have successfully completed the following CMI Accredited Trainings
Date, Location, and Name of Lead Trainer
Your answer
I have read and understand to my satisfaction the program, requirements, and expectations of the CMI LLCT Training
Name/Signature (typing your name will serve as your signature in digital format).
Your answer
Date
MM
/
DD
/
YYYY
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