New Client Information Form
Part 1: Contact Information
| Contact and Personal Information | |
| Name: | Birthday: |
| Position | Company/District |
| If District, Campus/School Name: | |
| Address (Work): | City, State, Zip |
| Address (Home): | City, State, Zip |
| Work Phone: | Cell Phone: |
| Email – Primary: | Email – Secondary: |
| Fax: | |
| Name/Relationship of important people in your life (spouse, partner, children, friends, etc.
|
|
Part 2: About You
| Your History |
| 1. What are three achievements you are most proud of? |
| 2. What are behaviors or skills did you develop or use in reaching these achievements that you can use with future endeavors? |
| Your Life |
| 1. Who are or have been important people in your life? |
| 2. What do you admire and want to emulate about these people? |
| 3. What are the five most positive things in your life? |
| Your Self Today |
| 1. What five to seven words describe you? |
| 2. What motivates you? |
| 3. What drains you? |
| Your Potential |
| 1. What would you want your legacy to be? |
| 2. What do you want to accomplish this year? |
| 3. What do your want to accomplish in the next three years? |
Part 3: Moving Forward
| Getting Started |
| 1. What will make our coaching relationship beneficial to you? |
| 2. How can I be most helpful to you in accomplishing your results? |
| 3. How will you measure the effectiveness of our coaching experience? |
| Previous Professional Development (for School District Personnel Only) |
| 1. Have you completed Carolyn Downey’s 3 Minute Walk-through training? |
| 2. Have you completed trend Walk-through training?
School View? Dana Center/Teachscape? |
| 3. Have you completed Coaching Training?
If so, through what training organization? How many hours/workshops, classes? |
| 4. Please return your resume electronically with this form. (optional) |
Part 4: Additional Information
| What You Would Like Me to Know |
| Please feel free to share anything with me about yourself that will assist us in creating a powerful coaching partnership.
|
I have received and read the policies of Close Coaching and Consulting. Please check the appropriate line before returning this form.
______ I accept the policies _____ I do not accept the policies