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* 1. First and Last name:

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* 2. Email:

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* 3. What is your gender identity?

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* 4. Affiliation:

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* 5. School/Division:

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* 6. How did you hear about Wellness Coaching?

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* 7. Which Facet(s) of Wellness would you like to focus on?

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* 8. Among the list below, please indicate what you would like to work on with your Coach (check all that apply):

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* 9. What are your biggest changes you want to make in your life in the next 3 months?

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* 10. What do you feel stops you from achieving these changes?

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* 11. Before completing this registration form, please schedule your first session here. After that, you will need to complete two assessments: VIA Strengths Assessment and the Well-Being Assessment. The Well-Being Assessment will ask for your coach's email. If you have been assigned to Layla Matariyeh, laysheh@uchicago.edu; Elizabeth Webb, mewebb@uchicago.edu. Please upload the results of your VIA Strengths Assessment. No purchase is necessary. *NOTE: PLEASE DO NOT FORGET TO SUBMIT THIS REGISTRATION FORM ONCE YOU HAVE COMPLETED THE ASSESSMENTS AND SCHEDULED YOUR FIRST SESSION*

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