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Coaches - An Invitation

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Coaches - An Invitation

  Experienced Coaches Application Form

(Save this form to your word processor, complete the form and then email, fax or mail to Coachabunda.com.)

We are a growing panel of exceptional coaches providing services to clients internationally.  To apply and become one of our Coach Applicants simply complete the form below.  Completing the form does not commit you or Coachabunda.com and is only the first step in our evaluation process.  Current liability coverage is required, advanced degrees, licenses or certifications are preferred.  We offer attractive compensation and are developing programs to attract a broad selection of coach-seeking clients.

First Name:                                Office Phone Number:               

Last Name:                                Office Fax Number:               

Street Address:               

City:                            State:                   

Zip Code:                    Email Address:               

Web Site URL:               

Social Security Number or Tax ID Number:        

Incorporated?                  Yes     No

Current Session Rate: $       

Number of Minutes of Average Session:                   

Number of Average Sessions Per Month:  

Other Information About Your Billing Arrangement That You Want to Provide:               

Approximate Date You Began Coaching:                   

Number of Years Experience in Coaching:               

Certifications You Hold (indicate name, date of certification, date of expiration and certification granting agency name):

License You Hold (indicate name, State that you are licensed in, date of licensure, date of expiration and certification granting agency name):   

Education (indicate name of institution, dates attended, graduation date, degree or certificate and city and state of institution)               

Indicate specific or general niche areas that you are competent to accept referrals in (be as specific as possible in as few words as possible to aid in the compilation of this information): 

Significant Work Experience Related to Coaching Practice (indicate title of position, organization name, location and dates):

Brief statement of what you would want clients to know about you or your coaching practice:

Special Media Coverage, Awards or Honors: 

Have you been convicted of any felonies?     Yes      No 

Has any disciplinary action ever been taken against you by a certification, licensing or any other type of organization?                 Yes     No 

Do you carry malpractice insurance?   Yes    No    Carrier                

I certify the above information is accurate.

Name:      Signature:   Date:   

Coachabunda.com  3875 Telegraph Rd. PMB 115 Ventura, CA 93003
application@coachabunda.com

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