CoachSource External Coaching Engagement Form

Leader Coaching Request Form

Completing this form is the first step in the coaching process. We will use the information provided to identify coaches who would be a good fit for this coaching request. Please note that all data in this form is confidential and is only shared with the very few coaches we nominate in order to outfit them with further information.

Your Information

Your company *

Your name

Your email address

Your title

How many levels/layers below CEO is this leader (e.g., n-4, n-3, etc.)?

Region

Name of CoachSource Contact (if applicable)

Logistical Information

Leader location

Coaching location preference

Location doesn't matter -- let's find the most suitable coach anywhere

Up to 1-2 hour flight is acceptable

Must be within driving distance

Coaching will be almost all by phone so location is not important

Other (specify)

Assignment length

6 months

1 year

Unknown, to be determined

Cost expectations

We are flexible -- let's find the most suitable coach first

We have not yet discussed or are unsure of the budget/cost

Total expense up to Total expense up to

Allowed characters: 0-9 and decimal point

Other (specify)

Hourly rate (specify) Hourly rate (specify)

$ / hr.

Allowed characters: 0-9 and decimal point

Please note: there is no fee associated with telephone/video introduction interviews or face-to-face interviews within a 1-hour driving distance of the coach being interviewed. Any travel costs accrued for face-to-face interviews greater than 1-hour driving distance of the coach being interviewed may be subject to reimbursement to the traveling coach.

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