Name:
Coaching Business Name:
Date Of Birth: month: day: year:
   
Business Address:
Business Phone
 
Home Address:
Home Telephone:
   
Mobile Phone:
Email:
Email - Alternate:
Fax:
 
Business Website(s):
 
Social Network URL(s) and Identities (ie. Facebook - Coach4men)
 
Employer if not self:
Training & Education in the
Coaching Field: Organization(s)
and Program Duration
Coaching Organizational
Afflliations:
 
Coaching Areas of Focus — Niche
Listings on other Coach Listings
(URL of Listing)
How many years have you been working speciflcally as a Coach?
Coaching Certiflcations
 

Are you currently working with a coach?

 

Yes No

 

Work other than your Coaching Practice
   

1. What do you expect from membership in the Gay Coaches Alliance?

   

2. What additional offering(s) would you like to see from the Gay Coaches Alliance?
   

3. What can you offer the Gay Coaches Alliance (does not indicate your commitment to do so)?

   

4. As a coach what are you passionate about?
   

5. What are you primary challenges as a coach?

   

6. Are you satisfled with the size of your practice? The income you earn as a coach?

   

7. What parts of running your coaching business are most challenging or least satisfying?

8. How did you hear about the Gay Coaches Alliance?