General Information
Address
(line 1)
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City
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Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antartica
Antigua and Barbuda
Argentina
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Australia
Austria
Azerbaijan
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Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
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Bhutan
Bolivia
Bosnia-Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
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El Salvador
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Ethiopia
Faeroe Islands
Falkland Islands (Malvinas)
Fiji
Finland
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Gabon
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Guinea
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Guyana
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Heard and McDonald Islands
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Hungary
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India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey, C.I.
Jordan
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Kenya
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Korea, Dem. People's Rep of
Korea, Republic of
Kuwait
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Mali
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Mexico
Micronesia, Fed. States of
Moldova, Republic of
Monaco
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Netherlands
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Nigeria
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Northern Mariana Islands
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Thailand
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U.S.Minor Outlying Islands
Uganda
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Virgin Islands (British)
Virgin Islands, U.S.
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Yugoslavia
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State/Province
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Alabama
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Vermont
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Zip/Postal Code
E-Mail*
How did you hear about Blanchard Coaching?
Approximately how many hours per week would you be
willing to dedicate to Blanchard Coaching clients?
Have you completed ICF Accredited Coach Training
360 Certification
Booth 360
Lominger Voices 360
Other:
Work Experience - Please provide us with the
past 10 years of your work experience.
Coaching Experience
Do you have a coach?
How long?
<Select>
0-6 months
6-12 months
1-2 years
Over 2 years
How did you get started in coaching?
How many years have you earned money as a coach?
What percentage of your business is coaching?
<Select>
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Please select all industries you have worked in. (Use
Ctrl key for PC or Command key for Mac to select multiple industries or to deselect.)
Advertising
Education
Energy & Utilities
Entertainment & Media
Financial Services
Government
Healthcare
Hospitality
Insurance
Internet
Manufacturing
Non-profit
Professional Services
Real Estate
Retail
Technology
Telecommunications
Other
Other:
Please describe your typical client? (Choose top 3)
Small business owner
Sr. Executive
Middle Manager
Team leader
Business professional
Other
Average number of months you work with clients
<Select>
0-3 months
3-6 months
6-9 months
Over 9 months
Average number of hours you meet with client per month
<Select>
0-1 hours
2-4 hours
5-10 hours
Over 10 hours
Comments about your clients:
What percentage of your time coaching a client is done
over the phone?
<Select>
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
What languages can you coach in? Ctrl-click (PC) or Command-click (Mac) to select multiple items
Arabic
Armenian
Belarusian
Bulgarian
Catalan
Chinese
Croatian
Czech
Danish
Dutch
English
Esperanto
Estonian
Filipino
Finnish
French
German
Greek
Hebrew
Hungarian
Icelandic
Indonesian
Italian
Japanese
Korean
Latvian
Lithuanian
Norwegian
Persian
Polish
Portuguese
Romanian
Russian
Serbian
Slovak
Slovenian
Spanish
Swedish
Thai
Turkish
Ukrainian
Vietnamese
Please list all software applications that you are
familiar with.
Additional Information
Given what you know so far, what makes you interested
in Coaching.com?
What experience do you have coaching leaders?
How familiar are you with the SLII® Model?
<Select>
Very familar
Somewhat familiar
Not at all familiar
If you are familiar with it, what experience do you
have applying it?
Describe any experience you have with sales or coaching
salespeople.
What are some of your favorite models/concepts/frameworks/principles
that you use consistently in your work?
If you could change one thing about the world in this
lifetime, what would it be?
In your lifetime, who are your heroes?
Please describe your most interesting experience of
the past 3 months?
References - Please list three references. (Include
1 coaching client.)