Peer Coaching Exchange Intake
(Coaching Circles)
Personal Information
Are you 18 years old or older?
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Legal Name: {"type":"text","name":"__generic20","width":65,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":""}
First Name
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Last Name
What Name Should I Use In Our Communications?
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What Time Zone Are You In?
choose oneAlaska Standard Time (AKST)(Arabic) Egypt Standard Time (ART)Argentina Standard Time (AGT)Atlantic Standard Time (AST)Australia Central Time (ACT)Australia Eastern Time (AET)Bangladesh Standard Time (BST)Brazil Eastern Time (BET)Canada Newfoundland Time (CNT)Central African Time (CAT)Central Standard Time (CST)Chamorro Standard TimeChina Taiwan Time (CTT)Eastern African Time (EAT)Eastern European Time (EET)Eastern Standard Time (EST)European Central Time (ECT)Greenwich Mean Time (GMT)Hawaii-Aleutian Standard Time (HST)Indiana Eastern Standard Time (IET)India Standard Time (IST)Japan Standard Time (JST)Middle East Time (MET)Midway Islands Time (MIT)Mountain Standard Time (MST)Near East Time (NET)New Zealand Standard Time (NST)Pacific Standard Time (PST)Pakistan Lahore Time (PLT)Phoenix Standard Time (PNT)Puerto Rico and US Virgin Islands Time (PRT)Samoa Standard Time Solomon Standard Time (SST)Universal Coordinated Time (UTC)Vietnam Standard Time (VST){"type":"select","name":"__generic3","width":40,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"choose one\nAlaska Standard Time (AKST)\n(Arabic) Egypt Standard Time (ART)\nArgentina Standard Time (AGT)\nAtlantic Standard Time (AST)\nAustralia Central Time (ACT)\nAustralia Eastern Time (AET)\nBangladesh Standard Time (BST)\nBrazil Eastern Time (BET)\nCanada Newfoundland Time (CNT)\nCentral African Time (CAT)\nCentral Standard Time (CST)\nChamorro Standard Time\nChina Taiwan Time (CTT)\nEastern African Time (EAT)\nEastern European Time (EET)\nEastern Standard Time (EST)\nEuropean Central Time (ECT)\nGreenwich Mean Time (GMT)\nHawaii-Aleutian Standard Time (HST)\nIndiana Eastern Standard Time (IET)\nIndia Standard Time (IST)\nJapan Standard Time (JST)\nMiddle East Time (MET)\nMidway Islands Time (MIT)\nMountain Standard Time (MST)\nNear East Time (NET)\nNew Zealand Standard Time (NST)\nPacific Standard Time (PST)\nPakistan Lahore Time (PLT)\nPhoenix Standard Time (PNT)\nPuerto Rico and US Virgin Islands Time (PRT)\nSamoa Standard Time \nSolomon Standard Time (SST)\nUniversal Coordinated Time (UTC)\nVietnam Standard Time (VST)"}
Meet-n-Greet Session
Training Status
(please mark which one applies to you)
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{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"If this question does not apply just type \"N/A\" (for not applicable)","height":80,"placeholder":"If 1st or 2nd choice marked in this question, please list Program name and level completed (for example: ABC Training, ACC; OR - a 60 hour or 125 hour course)"}
(please mark which one applies to you)
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(if none of the above applies, fill us in about your training)
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I am seeking Coaching Exchange for the following:
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How did you hear about this program?
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Which Choice interests you most?
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I am interested in participating in more than 2 Coaching Circles at a time.
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Anything you would like to share or that we should know about you?
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Let's get you set up for our Meet and Greet. We can discuss details about scheduling and additional opportunities at that time.
I am honored to be a part of a Coaching Exchange with you. Please let me know what days and times work best for you, and which ones don't.
Let's get started.
616-730-1204
Caren Robinson
