Premier Coach Application Survey

How to Become an eWomenNetwork Premier Coach

If you would like to be considered for one of our Premier Coach positions, please complete the following application.

1. Are you currently a member of eWomenNetwork?

Are you currently a member of eWomenNetwork? Yes, I am an active eWomenNetwork member

No, I am not currently a member of eWomenNetwork

No, but I plan to join today

Other (please specify)

2. Are you currently an eWomenNetwork certified Dream Coach through the Marcia Wieder program?

Are you currently an eWomenNetwork certified Dream Coach through the Marcia Wieder program? Yes, I am a certified Dream Coach.

No, I am not a certified Dream Coach.

I am not a certified Dream Coach, but would like to receive more information.

Other (please specify)

3. If you are a current eWomenNetwork member, how long have you been a member?

If you are a current eWomenNetwork member, how long have you been a member? Just joined

Less than one year

1-2 years

2-3 years

3-4 years

4-5 years

5-6 years

6-7 years

7-8 years

8-9 years

9-10 years

4. If you are an eWomenNetwork member, what Chapter do you currently attend?

If you are an eWomenNetwork member, what Chapter do you currently attend?

5. Have you performed at least 100 hours of coaching for clients?

Have you performed at least 100 hours of coaching for clients? Yes, I have performed 100 hours or more coaching clients

No, I have not yet completed 100 hours of coaching clients

Other (please specify)

6. Please list any coaching certifications from accredited coaching organizations or universities.

Please list any coaching certifications from accredited coaching organizations or universities.

7. Tell us about your background and your coaching experience.

Tell us about your background and your coaching experience.

8. Do you have area within coaching that you specialize?

Do you have area within coaching that you specialize? Yes

If yes, please explain your area of coaching specialization:

9. Please provide a brief explanation for why you want to be considered as a Premier Coach of eWomenNetwork.

Please provide a brief explanation for why you want to be considered as a Premier Coach of eWomenNetwork.

10. What percentage (%) increase in new coaching business would you like to see?

What percentage (%) increase in new coaching business would you like to see? I can handle a 100% increase in new coaching business

75% increase

50% increase

25% increase

Other (please explain):

11. Please check all that apply to you below:

Please check all that apply to you below: I currently offer 1 free initial coaching session

I currently offer 2 free initial coaching sessions

I do not offer any free coach sessions

12. Did someone recommend that you apply to become a Premier Coach?

Did someone recommend that you apply to become a Premier Coach? Yes

If yes, please provide their name:

PLEASE PROVIDE THREE (3) COACHING CLIENT REFERENCES:

13. Reference #1:

Reference #1: Name:
City:
State/Province:
Email Address:
Phone Number:

14. Reference #2:

Reference #2: Name:
City:
State/Province:
Email Address:
Phone Number:

15. Reference #3:

Reference #3: Name:
City:
State/Province:
Email Address:
Phone Number:

16. Please provide your contact information:

Please provide your contact information: First Name:
Last Name:
Company:
Address:
City:
State/Province:
ZIP/Postal Code:
Phone Number:
Email Address:
Website: