Mentor Coaching Group Registration for Y Staff
The Mentor Coaching Group is a professional service provided by 'Coaching & Training / Wolfgang Jani'. Please fill out all required information in this application form. We will contact you upon receiving your application and confirm your participation and next steps in the program, if you have been accepted. Information from this application will help the Mentor Coaching Group Director to process your application. The information provided will be used to determine eligibility for participation in this program and will only be used for screening and administrative 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: PLEASE ALSO BE AWARE: Your personally identifiable information is not shared beyond the scope of the training purposes. You can read our terms of privacy policy here:
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Your Full Name (First & Last) *
Your Email *
Your mobile phone (including country code) *
Date of birth *
Nationality *
City & Country of Residence (needed to determine time zone for group calls) *
Language aptitude (the course is only offered in English and you must have good conversational English to be able to coach others and be coached by them, as well as in order to participate in the discussions) *
Coach Training Information (what coach training and other coaching education/courses you have completed or are in the process of completing)
Name of course and organization through which you received your coach training (include all trainings, if it applies). *
When did you complete your coach training? *
How many hours of coach training have you completed? *
How many hours of 1-on-1 coaching have you completed so far? *
Credentialing Information
I plan to apply for an ACC or PCC credential with the ICF *
I plan to apply for the following credential with the ICF *
When is the best starting month for you (the 7 teleclasses would be spread out over at least 3 months)? Check all that apply! (most likely, no teleclasses in the month of July) *
I am able to meet my financial obligations to pay for the tuition *
If you answered 'No', please explain how you plan to pay for the tuition
By signing (type your full name), I verify that the above information is accurate *
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