Sam Synett Coaching Application Form
This form helps Sam determine if her coaching services are the best fit for your needs and goals. Sam currently reserves individual coaching slots for the clients she view as the best match for her coaching style, expertise, and current interests. This application is simply to gauge if your needs are a good fit for the kind of support coaching offers. Should you be invited to work with Sam, your coaching package options will be shared for you to select from. 

Coaching is a collaborative partnership in which the client and coach work together to develop a plan of action towards the client's goals. Sam offers specific strategies and tools to aid the client in overcoming any blocks or problems and provides accountability so that the client remains focused and on track. The client is in the "driver's seat" making decisions, while the coach is in the "passenger's seat" giving gentle, yet direct guidance along the way. 

Please remember: while Sam's clients get the benefit of her training/background as a Licensed Clinical Social Worker and mental health professional, coaching is not therapy. Should Sam determine you are not a best fit for her coaching services at this time, she will provide you with appropriate referrals for other coaches or possibly, mental health services. 

Some of these questions require self-reflection, but that's what coaching is all about! Just do your best, and Sam will follow-up soon!
Google にログインすると作業内容を保存できます。詳細
Please enter your name, email, and today's date. *
Please share any information about your personal identity that feels important for Sam to know if she were to work with you! (e.g., race/ethnicity, sexual orientation/gender identity, marital status, disability, cultural/faith traditions, etc.). Feel free to skip this question if you're not comfortable with sharing. It is completely voluntary.
Please share any information related to your mental health that feels important for Sam to know if she were to work with you! (e.g., any current diagnoses, any current care or services you are receiving for mental health, how you feel about the current state of your mental health in general, etc.)  Feel free to skip this question if you're not comfortable with sharing. It is completely voluntary.
In 4-6 sentences, tell me a bit about yourself and where you are in your life, business/career, health, finances, and/or relationships. *
What are your top 3 goals right now?  *
What is stopping you from accomplishing these goals? *
What have you tried so far to reach these goals? Has anything helped? *
What has made you interested to work with Sam in particular? *
What do you need in terms of support and accountability? *
Where do you see yourself in the next year? *
Coaching requires a time investment. Think about your current schedule and responsibilities. How will you make your work inside of coaching a priority? If unsure, please say so. *
Coaching requires an emotional investment related to being willing to address your blocks and embrace change. How open are you to doing the inner work necessary to reach your goals and meet your highest self? *
Completely unwilling
Willing to do whatever it takes
Fees range between $125-$350/hour. Multiple payment plans available to everyone. 

Sam asks clients to consider paying more or less based on a privilege-based sliding scale policy that you can review here: https://docs.google.com/document/d/1IqwRnoEu29zdXMzUPM6d63DEXCpBJzJsawZnHe_eNwo/edit?usp=sharing *
What excuses or blocks, if any, do you anticipate arising between the time you submit this form and when you actually start coaching? (or type n/a if you are *all in*) *
If you had the support/plan to overcome this excuse/block, would you move forward immediately? *
What other questions do you need answered about coaching at this time? Keep in mind that Sam will send you information on logistics (time frames, fees, frequency of meeting, etc.) if she determines you are a good fit.
送信
フォームをクリア
Google フォームでパスワードを送信しないでください。
このコンテンツは Google が作成または承認したものではありません。 不正行為の報告 - 利用規約 - プライバシー ポリシー
Google フォーム