Please answer the following questions
Not at all
Totally
1
2
3
4
5
6
7
8
9
10
1. I am an effective team player
2. I am coach-able
3. I am willing and able to live abroad for 6 months
4. I am committed to speaking the truth even if it hurts
5. I have a healthy spiritual practice
6. My business vision includes partnership
7. I am ready to risk my ideas of who I think I am in the world
8. I am committed to deepening the realization of my value
9. I am fluent in the following languages:
Describe what you know to be true about your self in 5 words or less:
Have you ever worked with a coach:
yes no
If yes, for how long?
How did you benefit from this experience?
Preferred communication method: (check one)
in person email phone
What 3 Roundtable Topic(s) interest you the most?
Spirituality Truth Compassion Value Integrity Action Motivation Joy Purpose Courage Fulfillment Soul Other:
Contact information
First Name:
Last Name:
Email:
Website:
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