Executive Coaching Screening Sheet
Please complete this form 3 days prior to our initial screening call.
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What is your name?
Email Address
What is the job title or role in which you are currently engaged? (ex. Director, FT parent, PhD candidate, Emerging Artist, Freelance journalist, Unpaid Community Organizer)
How old are you?
How do you spend the majority of your waking hours?
Why do you need an executive coach?
What are your goals?
What is a change you want to make?
What steps or practices have you taken or developed already towards these goals?
Who is your supervisor and what kind of support do you get from them?
Do you go to therapy regularly?
Clear selection
When was the last time you changed a habit or behavior to work towards a goal?
What is your organization's annual budget?
Whatis your organization's monthly (or annual) budget for coaching and professional development per employee?
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