Coaching Application — She, Imprints

She Imprints presents EMERGE: A Coaching Community for Women of Color Leaders - Intake Form

Thank you for your willingness to go deeper with your care, and for entrusting me as a part of this journey with you. Please take some time to complete this form when you have a moment to be with yourself. This form is designed to provide me with information so that I can get a better idea of how to support you through a combination of both wellness/healing modalities and coaching. This also gives me an idea of whether my offerings are a best fit for your needs during this season.

Name

First Name

Last Name

What is your professional work or practices or how would you like to describe your employment?

What is the best email address for correspondence with you?

Why are you specifically interested in this coaching program?

What are your wellness goals for yourself? The more specific you are, the better!

What are your current wellness practices or routines?

Where/how do you feel most supported as it pertains to achieving your wellness goals? What does this look like for you?

Investment: Wellness coaching can be a really full investment into self. It is essential that we have a full understanding of the importance of investing in our wellness. This current offering is the 7 week program at an investment of $2450. Would you like to pay in full or a weekly or bi - weekly payment plan? Or, will your employer be paying in full?

Pay in full

Weekly payments

Bi weekly payments

My employer will be paying in full for this program

For wellness coaching, I use a combination of meditation, yoga, Reiki, chakra balancing, goal setting as well as employing other tools and strategies. Are you familiar with the practices mentioned above? Do you have any questions about them?

How did you learn about me or this program?

Are you currently under the care of a therapist?

Yes

Currently searching for a therapist

If you have had a wellness or leadership coach in the past, please describe your experience(s). What did you enjoy? What did you not enjoy?

Is there any helpful information that would be helpful for you to share with me before we begin our work together?

Any questions?

She Imprints presents EMERGE: A Coaching Community for Women of Color Leaders - Intake Form

Serving at the intersection of wellness and justice for women and girls of the global majority.

info@sheimprints.org