Application for Certification

Have you completed the Foundational Coaching Clinic or at least 16 hours of approved coach-specific training based on ICF Core Competencies and the QuickStep Coaching Practicum? (If not, do not submit this form. If you are uncertain, contact the QuickStep Coaching Coordinator using the Contact Us form.)*

Yes

No

Have you coached at least five (5) sessions since taking the QuickStep Coaching Practicum?:*

Yes

No

Name:*

First

Last

Gender:*

Male

Female

E-mail:*

Best Phone Number:*

Area Code

-

Phone Number

Address:*

Street AddressCityState / Province / RegionPostal / Zip Code

Your current profession or occupation and place of service:*

How long have you been coaching?*

Less than 12 months

1 - 2 years

3 - 5 years

More than 5 years

When did you last coach someone? (Month / Year)*

Was it for pay or "pro bono"?*

Pay

Pro Bono

Rate yourself on the quality of your last coaching session using a scale of 1 - 10. (1 = Poor, 10 = Excellent)*

Have you ever coached a client for more than 5 consecutive sessions?*

Yes

No

Where did you receive your basic coach-specific training?*

Foundational Coaching Clinic

CoachU or Coach Inc.

Coaching4Clergy

Other

If other, list all coach-specific training you have received. (Name of course, number of hours, training provider, year of training.)

Highest level of coach training based on ICF Core Competencies:*

16 hours of coach-specific training

Between 16 - 59 hours of coach-specific training

60 or more hours of coach-specific training

ICF Credentialed Coach (ACC, PCC or MCC)

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