Coaching Application - Patsy Clairmont

All About You

Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Your Age*

Who is in your immediate family?*

Your Goals and Background

What area do you most want to focus your coaching on?*

Writing
Speaking
Self Discovery
Creativity
Other

Do you have experience in speaking or writing? If so, please share.*

What area(s) do you need encouragement in?*

Have you had any previous coaching or trainings? If so, was that successful? What did you like and dislike?*

At the end of our time together, what do you hope to have accomplished?*

Your First Assignment

Assignment #1*

Please write your own bio that would be used on the back of a book or for a speaking engagement. (Typically 75-100 words)

Anything else you would like to share?*

I’m so looking forward to our time together.

Before we chat, I’d love to put a face with your story. Please use this link to record a quick video. Don’t overthink it…just share with me your name, where you live and what do you hope these conversations will do for you?

Note: Videos must be less than 5 minutes.

Last Step to Prepare for Your Mentoring Session:

Patsy Clairmont Mentoring

All About You

Your Goals and Background

Your First Assignment

I’m so looking forward to our time together.