Thank you for choosing Potential Unleashed Consulting for your organizational coaching engagement related to equity, diversity, access, opportunity, and belonging. This brief intake form will help us understand your organization, identify key priorities, match you with the appropriate member of our team, and ensure our coaching conversations are focused on the equity related outcomes that matter most to you.

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1. Organization Name: (Required.)

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2. Primary Contact: (Required.)

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4. Phone (Required.)

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5. Number of Employees / Team Members:

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6. What is the primary reason your organization is seeking coaching? (Required.)

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7. Briefly describe what is happening within your organization or team that prompted you to seek coaching. (Required.)

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8. What would you like to be different as a result of this coaching engagement? (Required.)

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9. What are the top 1–3 challenges currently affecting your organization or team? (Required.)

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10. How would you describe your team’s current level in each area? (Required.)

  Strong},{ Developing Challenging
Communication
Trust
Accountability
Collaboration
Alignment

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11. Who (besides you) will participate in the coaching engagement? (Required.)

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12. Approximate Number of Participants:

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13. Is there anything else you would like your coach to know before we begin?

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14. Preferred Coaching Format:

Thank you for taking the time to complete this intake form. Your responses will help us create a coaching experience that is focused, practical, and aligned with your organization’s goals.

Potential Unleashed Consulting
Unleashing Potential. Transforming Culture. Elevating Leadership.

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