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:
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

Download New Client Information Form