enCharge Coaching Application

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1. Address

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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2. Occupation

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3. Date of birth

Date / Time

Date

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4. Marital status

Married

Single

Divorced or separated

It's complicated

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5. Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? (1 = Not at all, 10 = All the time) (Required.)

Clear

i We adjusted the number you entered based on the slider’s scale.

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6. Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? (1 = Not at all, 10 = All the time) (Required.)

Clear

i We adjusted the number you entered based on the slider’s scale.

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7. Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire with the world? (1 = Not at all, 10 = All the time) (Required.)

Clear

i We adjusted the number you entered based on the slider’s scale.

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8. Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? (1 = Not at all, 10 = All the time) (Required.)

Clear

i We adjusted the number you entered based on the slider’s scale.

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9. Influence: Do you feel you have the social influence with your family, friends, and team needed to accomplish your goals? (1 = Not at all, 10 = All the time) (Required.)

Clear

i We adjusted the number you entered based on the slider’s scale.

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10. What do you do for a living and why did you choose that career?

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11. What are the top three goals you are striving to achieve right now?

Goal 1

Goal 2

Goal 3

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12. What major stressors or challenges are you struggling with right now?

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13. When you feel like your most successful and happy self, what makes you feel that way?

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14. What would your dream life look like if you could wave a wand and make it happen?

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15. What has prevented you from having that dream life?

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16. What goal or dream have you ever given up on or failed at and what do you believe caused you to stop or fail?

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17. What three big changes would you like to make in your life in the next 12 months?

First change

Second change

Third change

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18. What are you most proud of and excited about in your life?

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19. What negative recurring thoughts, fears or behaviors would you like to overcome in order to feel more psychologically free, confident and successful?

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20. What eating, exercise or general health habits would you like to begin or break in order to feel stronger and more healthy physiologically?

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21. What distracts you the most from being more productive and what major projects or missions are you struggling to complete faster or more efficiently?

enCharge Coaching Application

Question Title

* 1. Address

Question Title

* 2. Occupation

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* 3. Date of birth

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* 4. Marital status

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* 5. Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? (1 = Not at all, 10 = All the time) (Required.)

Question Title

* 6. Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? (1 = Not at all, 10 = All the time) (Required.)

Question Title

* 7. Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire with the world? (1 = Not at all, 10 = All the time) (Required.)

Question Title

* 8. Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? (1 = Not at all, 10 = All the time) (Required.)

Question Title

* 9. Influence: Do you feel you have the social influence with your family, friends, and team needed to accomplish your goals? (1 = Not at all, 10 = All the time) (Required.)

Question Title

* 10. What do you do for a living and why did you choose that career?

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* 11. What are the top three goals you are striving to achieve right now?

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* 12. What major stressors or challenges are you struggling with right now?

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* 13. When you feel like your most successful and happy self, what makes you feel that way?

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* 14. What would your dream life look like if you could wave a wand and make it happen?

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* 15. What has prevented you from having that dream life?

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* 16. What goal or dream have you ever given up on or failed at and what do you believe caused you to stop or fail?

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* 17. What three big changes would you like to make in your life in the next 12 months?

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* 18. What are you most proud of and excited about in your life?

Question Title

* 19. What negative recurring thoughts, fears or behaviors would you like to overcome in order to feel more psychologically free, confident and successful?

Question Title

* 20. What eating, exercise or general health habits would you like to begin or break in order to feel stronger and more healthy physiologically?

Question Title

* 21. What distracts you the most from being more productive and what major projects or missions are you struggling to complete faster or more efficiently?

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* 22. If you were more persuasive or influential, what dream or desire would you ask others to support you in achieving?

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* 23. When do you struggle to be fully present in your day or in any of your relationships?

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* 24. How purposeful do you feel in living each day and how would you describe your purpose?

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* 25. Why would you like to work with a high performance coach?

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* 26. Why do you feel you could be a great student or coaching client if we worked together?

1. Address

2. Occupation

3. Date of birth

4. Marital status

5. Clarity: Do you feel you are clear about who you are, your purpose, and the direction you want to go in life? (1 = Not at all, 10 = All the time) (Required.)

6. Energy: Do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? (1 = Not at all, 10 = All the time) (Required.)

7. Courage: Do you take action and consistently express who you truly are and what you truly think, need, and desire with the world? (1 = Not at all, 10 = All the time) (Required.)

8. Productivity: Are you consistently focused and effective, and are you good at minimizing distractions and maintaining priorities? (1 = Not at all, 10 = All the time) (Required.)

9. Influence: Do you feel you have the social influence with your family, friends, and team needed to accomplish your goals? (1 = Not at all, 10 = All the time) (Required.)

10. What do you do for a living and why did you choose that career?

11. What are the top three goals you are striving to achieve right now?

12. What major stressors or challenges are you struggling with right now?

13. When you feel like your most successful and happy self, what makes you feel that way?

14. What would your dream life look like if you could wave a wand and make it happen?

15. What has prevented you from having that dream life?

16. What goal or dream have you ever given up on or failed at and what do you believe caused you to stop or fail?

17. What three big changes would you like to make in your life in the next 12 months?

18. What are you most proud of and excited about in your life?

19. What negative recurring thoughts, fears or behaviors would you like to overcome in order to feel more psychologically free, confident and successful?

20. What eating, exercise or general health habits would you like to begin or break in order to feel stronger and more healthy physiologically?

21. What distracts you the most from being more productive and what major projects or missions are you struggling to complete faster or more efficiently?

22. If you were more persuasive or influential, what dream or desire would you ask others to support you in achieving?

23. When do you struggle to be fully present in your day or in any of your relationships?

24. How purposeful do you feel in living each day and how would you describe your purpose?

25. Why would you like to work with a high performance coach?

26. Why do you feel you could be a great student or coaching client if we worked together?