Application for Coaching

    The first step to a new you!

    Please fill out the information on this form. All personal information will be held in the strictest of confidence.
















    Personal Assessment

    Please answer all questions completely. If The Question does not apply, Write "N/A"













    What you Should know about life Coaching

    This is what your Life Coach will do:
    1. Assist you in reaching a goal or make a change in your life.
    2. Provide a source of motivation and inspiration that gives you the push you need to reach your full potential. Like a personal trainer for your life goals.
    3. Help you develop a strategy to re-focus your thinking to make sure you’re going about reaching your goal(s) in an effective and meaningful way.
    4. Serve as an accountability partner for reaching your goals and making positive changes.
    5. Help you identify goals by listening to your dreams and ideas, and organizing them into tangible milestones. In a way, your coach will help you to connect what your head is saying and what your heart is saying to find some agreement between the two that points toward your passions.
    6. Help you achieve your goals by holding you accountable for achieving your vision for yourself.
    7. Guide you through changes and obstacles to move your life forward and to find meaning, fulfillment, success, well-being and happiness.
    8. If it is a part of the plan; guide you through a life transition, such as finding a new career, or looking to start a new relationship.
    9. Help you realize you don't need permission to follow your dreams.
    10. Teach you how to make the right decisions for yourself.
    This is what your Life Coach Will Not do:
    1. Give advice that tells you what to do. Your coach will try to help you find what feels right for you by helping you reveal the answers to yourself through discussion, suggestions, brainstorming and reflection.
    2. Provide business consulting through the life coach venue. That can be done at a cost in a different setting.
    3. Deal with your past issues through the life coach venue. Your coach may provide counseling and that can be done in a different venue. Your coach will not deal with issues like depression, anxiety etc. through life coaching.
    4. Focus on a certain problem you are dealing with and what got you there in the first place. Your coach will focus on solutions that will help you get to where you are going.
    5. Among other things, Your coach is not your consultant or best friend. Although life coaches are someone you consult about strategies and goals, they are life specialists not specific specialists like a business consultant, organizational manager or financial advisor. Your coach may specialize in these areas and you may be able to benefit from their expertise, but your coach is here to help you reach your goals, not give you data on how to grow, market or run your business.


      A God Send's funded Life Coach programs are based on experience and education; they are neither psychotherapy nor medical therapy.


      In the Life Coach relatioship, you will be invited to examine your life and various issues regarding your present life. You should be aware that if any of the issues have sadness or difficult feelings and emotions attached to them in the normal course of your life, it is likely that these same feelings and emotions will emerge in a session. You must decide whether this is something you can handle at this time. Your willingness to experience these feelings and emotions honestly, and then let go of them, can open the way to a more joyful experience of living. The choice to do so, however, and the degree of your participation in the process, rests with you alone.


      The information requested here is meant to enable your Life Coach to better support you. It is not possible for A God Send to predict any experience. If during the course you find yourself feeling uncomfortable notify your coach immediately.


      BY TYPING YOUR NAME IN THE BOX BELOW, you hereby acknowledge and attest that you have thoroughly and carefully read the information contained herein, that you understand it and agree to it, and that you have answered all questions truthfully.

    Financial Qualification

    Answer the following questions honestly and completely. Please be aware that this information is used by A God Send for purposes of verifying your eligibility for funded services.

    A God Send provides subsidized coaching when the need is verified. In order to be approved, it is necessary to provide aggregate household income data, which illustrates financial need. This figure is to include all sources of income -- i.e. salary, child support, maintenance, investment income, housing allowances, etc.



    Rent or mortgage, Utilities (like electricity and gas), Internet/cable, Phone(s), Groceries and household supplies, Child care, Credit card payment(s), Car loan, Child support you pay, etc.


    In the above box, please provide the NAME, RELATIONSHIP, and PHONE NUMBER of TWO Emergency Contacts who your coach may contact in case of emergency.