First Name
Last Name
Email
Best Phone Number
How did we find each other?
In your own words: what is your work in the world... and why does it matter ?
Why is NOW a good time for you to receive coaching? (i.e. What's happening? What's inspiring you? Or what needs do you feel the session can help address?)
Which of these best describes your work? Select... Working full time for a large organization Working full time for a small organization Working part time for an organization (large or small) Self employed Not currently working
Which of these best describes your role at work? Select... Founder / Creator President or CEO Senior Executive or Executive Senior VP or VP Director Senior Manager or Manager Technical or Product Lead Individual Contributor (Technical or Creative) Support Staff Other (please specify below)
Other (please specify)
If you are responsible for a team, approximately how many people do you lead or manage?
Would you like to be “having a greater impact” in 6-12 months? If so, describe what you imagine that could entail. (yes! give me the juicy details... what do you really want?)
What are your greatest strengths as a person or as a leader – and how do you currently use them for good?
What's your biggest "Achilles Heel" in your leadership or personal life – and how does it currently get in your way?
What have you already done (or what are you are currently doing) to improve the situation?
On a scale of 1-5 (1 being not important, 5 being urgent), how important is it for you to achieve your goals this year? Select... 1 2 3 4 5
What is your approximate annual income? (we ask this question for scholarship purposes) Select... Under $35,000 $35,000-$75,000 $75,000-$150,000 $150,000-$225,000 $225,000 or Above
Are you satisfied with your current income? Select... Yes No
Are you interested in a Guts & Grace Program? Select... Guts & Grace Mastermind Guts & Grace Retreat or MEME Summit Either / Both Neither, I prefer solo executive-level coaching Not Sure
Have you ever worked with a coach? If "yes," what was your experience?
The majority of our clients invest in their own coaching. This gives them the flexibility to truly set their own goals and change jobs if/when the time is right. However some clients do have a company budget to spend. If we were to work together, would you be planning to invest in your own coaching? Select... Yes, I am planning to invest in myself No, I’m hoping my company will pay No, I’ve already got my company’s approval but the budget is not clear No, I’ve already got my company’s approval and the budget is clear Most likely it will be half and half
In order to be considered for a discovery session please respond to the following statement: agree to be 100% open and coachable during our call. I am prepared to be present, to be honest, and am willing to take action in my life. Select... Yes No
Last but not least - imagine it's a year from now... and everything you dreamed of is happening. Describe what your life looks like (including success, income, relationships, energy, time, freedom, health, impact... you decide what matters!)
