Winston Mindset Coaching email@example.com 718-781-0225 Please Note: Before completing this application, be aware the application has 3 stages: Completion and submission of the application form. Acceptance to stage 2/or decline (with referral to an alternative coach if desired). Stage 2: Bryan will invite you to a 45-minute telephone consultation to discuss your application and growth objectives in more detail. At the end of this consultation, both parties can make informed decisions as to whether to engage or not, discuss terms, availability and start dates. Name First Last Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Qualification Questions1: What brings you to want a coach?2: Why now?3: What are the 3-5 main outcomes you want to accomplish from the coaching relationship?4: Describe the kind of engagement you think you need (i.e. what are you looking for from the expertise you want to hire?)5: What is your job title?6: How many direct reports do you have? If you are the business owner, how many employees do you currently have?7: Have you previously had (or currently have) a therapist and/or coach?YesNo8: What is your biggest challenge?9: In what ways have you tried to remedy this challenge?