Confidence Coach Feedback Form This form is for Volunteer Confidence Coaches to record their outreach and coaching sessions. Question Title * 1. Confidence Coach First Name Question Title * 2. Confidence Coach Last Name Question Title * 3. Meeting Date Meeting Date Date Question Title * 4. Client First Name Question Title * 5. Client Last Name Question Title * 6. Outreach or Connection Outcome Left a voice mail message Unable to leave voice mail message Had phone session Intro to Coaching session completed In-person session Reached out via email with response Reached out via email with no response Client called back and left a voice mail message Question Title * 7. Would you like to continue to coach this client or have them work with another coach? Yes No Question Title * 8. If not, please note a suggested coach or coach attributes/areas of expertise that would be helpful for this client at this time. Question Title * 9. Note client Confidence Coaching needs for support and assistance here: Question Title * 10. Any tasks or concerns you'd like staff to reach out to client about? Question Title * 11. Tell us about your client session today (example "client was upbeat and excited, client was tired and frustrated...") Question Title * 12. Demonstrated Motivation Score Low Demonstrated Motivation Score Medium Demonstrated Motivation Score High Demonstrated Motivation Score Low Demonstrated Motivation Score Medium Demonstrated Motivation Score High Demonstrated Motivation Score Question Title * 13. Demonstrated Focus Score Low Demonstrated Focus Score Medium Demonstrated Focus Score High Demonstrated Focus Score Low Demonstrated Focus Score Medium Demonstrated Focus Score High Demonstrated Focus Score Question Title * 14. Estimated Time for session (number in minutes) Done