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)

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)

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)

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)

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)

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

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* 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)

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)

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)

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)

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)

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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?

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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?