Intake Form: Jeong Coaching & Consulting LLC

Basic Information

Please note that the fields regarding demographic information are entirely optional. Yejin of Jeong Coaching & Consulting LLC only uses this information to calibrate her equity-informed approach to coaching, consulting, and facilitation work. This data is not shared with any other person or entity. 
1.Your Name(Required.)
2.Your Pronouns(Required.)
3.Your Email Address(Required.)
4.How did you hear about Yejin and her equity & justice services?(Required.)
5.[Optional] Name of Organization
6.Your Race (please self-describe)
7.Your Gender (please self-describe)
8.Other Identities that Matter Most to You
9.Please select which service you are interested in(Required.)