Coaching Club Application

Thank you for your interest in this program. Please answer the following questions. You do not need to write an essay for any of the answers. 2-3 sentences is best unless otherwise specified. I estimate it will take about 15 minutes to fill out the form.

After I receive your application, I will contact you to schedule a phone call to discuss the program further and determine if this program is a match for us both.

I acknowledge you for being so committed to your business.

Contact Scott if you have any questions.

Application

Your Name(required)
Business Name
Website
Address, City, State (Province), Zip (Postal)
Country(required)
Home Phone(required)
Office Phone
Email(valid email required)
Birthday - click calendar below to input date
What days would you be available for the conference calls?
Thursday Friday Monday Tuesday Wednesday
What times would you be available for the conference calls?
morning afternoon evening
What time zone do you live in?(required)
Please describe your business in one sentence.(required)
On a scale of 1-10, how satisfied are you in each area of your business? (1 is not satisfied at all, 10 is super satisfied)
Income/Profit (required)
Workload (required)
Marketing (required)
Work environment (required)
Discipline(required)
Systems (required)
Mindset (required)
What do you want MORE of in your business?(required)
What do you want LESS of in your business?(required)
What holds you back from achieving your goals and dreams in your business?(required)
What interests you most about participating in this program?(required)
What difference do you anticipate as a result of participating in this program?(required)
What SPECIFIC goal(s) would you like to accomplish over the next 4 months as a result of this program?(required)
On a scale of 1 to 10, (10 being highest) what level are you willing to commit to this program? (required)
What else would you like me to know about you?
This is a new form. Did you have any trouble filling out the form? If so, please explain.(required)

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Contact Scott if you have any questions.

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Coaching Club Application