Coaching Program Application by jgdQQ5M7


									            Application for the Socialnaire Coaching Club

                                      General Information
Your Name
Primary Email Address
Where You’re From
Where You Relocated (or Will
How You Learned About The
Socialnaire Coaching Club

 Why do you want to be part of The Socialnaire Coaching Club?

 What do you hope to gain from the Coaching Club?

 Why is this (what you wrote in the previous answer) important to you? What will you gain
 in your life if you are able to accomplish this?

 What assets/skills do you feel you would bring to the group?

   Coaching Club Heather Markel | Culture Transition
   Application 1 Coaching
Describe your ideal support system – Do you have people in your life who believe in you,
encourage you, challenge you and see you through hard times? Who are they, and what do
they do that makes you feel supported?

Who inspires you, and how do they inspire you?

List some qualities of your best friend – present or past. What made him or her your best
friend above all others?

Are you willing to participate actively in calls and homework assignments?

What do you feel is currently holding you back from making new friends, or standing in the
way of you accomplishing this goal?

Why is it important to you that you have a social network – what will it mean in your life?

What kinds of friends are you interested in making?

How much time do you have each week to invest in this program?

Are you willing to let go of old ideas, and accept full accountability and responsibility for
building your social network?

                                                     CONTINUED ON FOLLOWING PAGE

 Coaching Club Heather Markel | Culture Transition
 Application 2 Coaching

Commitment                                                   Yes          No
I promise to do the weekly assignments to the best of
my ability
I promise to participate on monthly calls by attending,
asking questions, contributing to discussions, and
helping other club members
I promise to ask for help when I need it.
I understand I am fully accountable for my success or
my failure. It is up to me to complete assignments and
contribute to the club to make new friends.
I understand that it is my choice to take action, and that
the results of those actions are my responsibility.

Payment and Cancellation Policy:

Please mark an “x” beside each statement to indicate your understanding and acceptance
of the terms below.

____ Once accepted into the program, you have 48 hours to complete payment. (If you plan
to be away during the 48 hours after submitting this application, you may alert Heather in
the body of your email as to when you will be available.) If you do not complete your
payment within this timeframe, your spot may be given to another applicant, and you are
welcome to apply for a future program.

____ The program lasts for 3 months. Once accepted, you will receive a payment link and
your credit card will be immediately debited $57. You will then be charged $57 once per
month, for the next two months, for a total of three $57 charges. The charges will appear
as “MARKELH”. You must pay in advance of each month in order to continue your
participation. Failure to pay in advance is grounds for dismissal from the program.

____ The times/days of the calls will be Weekday evenings, Eastern Time, unless due to
geographic spread of the group, we need to arrange a weekend call. In that case, monthly
calls will occur on a Saturday or Sunday afternoon, Eastern Time.

____ You may cancel your membership at any time during the first 30 days if you are not

 Coaching Club Heather Markel | Culture Transition
 Application 3 Coaching

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