Coaches Application

	Your Contact Information (Page 1 of 3) Please fill out your contact information below.
	First Name*
	Last Name*
	Address 1*
	Address 2
	City*
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	Zip/Postal Code*
	Country* United States Canada Australia United Kingdom * * OTHER: * * Afghanistan Akrotiri Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Arctic Ocean Argentina Armenia Aruba Ashmore and Cartier Islands Atlantic Ocean Australia Austria Azerbaijan Bahamas, The Bahrain Baker Island Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Cook Islands Coral Sea Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Dhekelia Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Islas Malvinas) Faroe Islands Fiji Finland France French Polynesia French Southern and Antarctic Lands Gabon Gambia, The Gaza Strip Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City) Honduras Hong Kong Howland Island Hungary Iceland India Indian Ocean Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Jan Mayen Japan Jarvis Island Jersey Johnston Atoll Jordan Kazakhstan Kenya Kingman Reef Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Midway Islands Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Namibia Nauru Navassa Island Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pacific Ocean Pakistan Palau Palmyra Atoll Panama Papua New Guinea Paracel Islands Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Southern Ocean Spain Spratly Islands Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Pacific Island Wildlife Refuges Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands Wake Island Wallis and Futuna West Bank Western Sahara Yemen Zambia Zimbabwe Taiwan European Union
	Office Phone*
	Mobile Phone
	Fax
	Email*
	Website URL

	Coaches Application

	Coaching Experience, Training & Programs (Page 2 of 3) Please describe your coaching experience, practice, training and certifications:
	Years of Coaching* 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years More than 10 years Please indicate the number of years you have been a coach.
	Number of Clients* 1-10 11-20 21-30 31-40 41-50 More than 50 Please indicate the approximate number of clients you have coached.
	Education* High School Diploma/GED Technical or Vocational Certification Some College Completed Associate's Degree Bachelor's Degree Master's Degree Doctorate (PhD) Please indicate the highest education level completed
	Coaching Training Completed - - - - - - - - - - - - - - - - * ACTP (Accredited Coach Training Programs): * - - - - - - - - - - - - - - - - Academy for Coach Training Academy for Coaching Excellence Academy of Executive Coaching Accomplishment Coaching Adler School of Professional Coaching Inc. Breakthrough Enterprises Coach 21 Co., Ltd. Coach For Life Coach U Coaches Training Institute Coaching de Gestion, Inc. Coaching Development, Ltd. Coaching Hall International CoachVille Co-Creative Alliance College of Executive Coaching Corporate Coach U International Corporate Coach U Italia Erickson College ESCUELA EUROPEA DE COACHING Fielding Graduate University FUTURE Training-Beratung-Coaching Georgetown University Center for Professional Development Gestalt Center for Organization & System Development Hudson Institute of Santa Barbara IDC INSTITUT DE COACHING Institute for Life Coach Training Instituto Internacional Olacoach Integral Coaching Canada Integrated Coaching Institute International Coach Academy International MOZAIK l'école du devenir International Teaching Seminars iPEC Coaching Life Coaching Academy Pty Ltd MentorCoach® New Ventures West Newfield Network, USA, LLC Results Coaching Systems Royal Roads University Strategic Executive Coaching Alliance Success Unlimited Network The University of Texas at Dallas Top Human Technology Limited Trinergy® International - - - - - - - - - - - - - - - - * ACSTH (Approved Coach Specific Training Hours): * - - - - - - - - - - - - - - - - Academy for Coaching and NLP Activision - Variations Portugal Career Coach Academy/Leadership Coach Academy Career Coach Institute Coach Training Alliance Coaching and Leadership International Inc. Coachubildning Sverige AB Corporate Coach U Italia Expand ApS Full Spectrum Coaching Instituto Internacional Olacoach Korea Coaching Center Leapfrog AB Life Purpose Institute METASYSTEME MORE Coach Next Step for Success THE CENTRE FOR COACH TRAINING Top Human Technology Limited ========================== Please indicate which coaching training you have completed. To select multiple items, press [CTRL] while selecting the desired items.
	Coaching Credentials* ACC PCC MCC WABC IAC Other: Other Value Please indicate your coaching credentials
	Credentials - Proof/Image Upload Please upload proof of your coaching credentials. Your file will upload when you click to submit your application. Please be patient; it may take a few minutes to transfer the file, depending on your connection speed and file size. There is a file size limit of 2 MB. The following file formats are accepted: pdf, jpg, jpeg, gif, png, bmp, tif, psd, doc, xls, txt, zip, gz, rar, tgz, tar, sitx.

	Coaches Application

	Your short bio and areas of interest/expertise Please give an example (if any) on contributions you have made to the coaching profession (e.g., recognition to coaching via a television show, awards, etc.  leadership positions you've held in the coaching profession, published books you've written (title, publisher, date published).
	Short Bio / Areas of Interest and/or Expertise