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Apply for Coaching
1-833-233-8398
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Book a Consultation
Let's find the right coaching plan for you.
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Your Contact Info
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Info
2
Coaching Plan
Coaching Plan
Coaching
Plan
3
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1. Your Contact Info
Please provide your own contact info, as well as your parent or case worker's.
First Name*
last Name*
Email*
Phone Number*
Parent or Case Worker's Name
←
Their Contact Info
2. Program Registration
We'll use this to determine the number of weeks and cost associated with your coaching plan.
Program Type
Fall Semester
Winter Semester
Summer Semester
Career Exploration
Executive Functioning Coaching
Consulting
WOrkshop
Other
Number of Sessions*
Start Date?*
Your Challenges, Experiences, and Thoughts*
Tell us about your experience coming up through elementary, junior high, high school, gap years, university, career, etc.
Tips
: What courses went well? What did you find challenging? What are your average marks? Where would you like to be?
3. Personal Information
We'll use this information to better understand how we can help you.
Neurodiversity Type:
ADHD
ADD
Autism
Learning Disabilities
Anxiety
Depression
Bi-POlar
Borderline Personalities
Other
Other Neurodiversity Type:
If you chose
other
, please specify what you are diagnosed with:
Coaching/Counseling History*
Have you worked with a coach, therapist, or tutor before?
Yes
No
Top 3-5 Challenges*
What are the top challenges you are having that come to mind right now?
Some Examples
: Time management, organization, stress management, procrastination, perfectionism, easily distracted, study skills, life skills, social skills.
Your Goals*
In the next 3 months, what would you like to accomplish?
Some Examples
: Higher grades, higher self-esteem, better awareness, stronger confidence, etc.
Your information is confidential and safe with us. We look forward to meeting you soon!
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You can also call us at
1-833-233-8398
for help.