confidential memo: Certificate & assessment form
Free Coaching Certificate
Download a copy of this confidential certificate here, and send as an attachment to:
assessment@easysuccesscoaching.com,
Easy Way Gift Certificate/ Review Form
Please submit all forms to Easy WAY COACHING no later than 48 hours from receipt.
ENROLLMENT FORM
Career/Business Assessment
1. Mention 3 major goals you want to move toward or would like to see happen.
#1:
#2:
#3:
2. What feels “hard”? Describe the 3 major sources of stress, frustration, or dissatisfaction that seem to be interfering with reaching your goals.
#1:
#2:
#3:
3. Describe what part of you (or your company’s) experience re: money or revenue you’d like to alter (if applicable). Mention any chronic obstacles/patterns.
4. Time & Your Schedule
Number of hours you work, average week _________
Number of hours you’d prefer to work, average week _________
Approx. No. of hours/wk you work “on” vs. “in” your career/business _________
No. weeks on vacation taken in pre-pandemic: _________
2021: _________
2022: _________
No. weeks vacation you’d prefer taking in 2023-4: _________
Optional (Reminder: All information is confidential)
Gross Career/Business Income
2021 or ‘22: $_________
Goal for 2023 or '24: $_________
Net Personal Income in 2021 or ‘22: $_________
Goal for 2023-'24: $_________
5. Rank the following based on their importance to you
(1 being Most Important to 6 being Least Important – please use all 6 numbers [1, 2, 3, 4, 5, 6]):
Ease re: Money: more income, stability, debt-reduced _________
More freedom in schedule & time to enjoy life _________
Breaking chronic patterns, such as procrastination or being “busy _________
Inspiring, engaging work that feels purposeful & makes a difference _________
Feeling less stress, more ease and serenity, peace of mind _________
Love/Relationship, Deeper connection to others _________
Personal Assessment
6. Rate yourself on the following, 1 being Low and 10 being High
Ability to follow through on a task _________
Willingness to take direction & be led by competent people _________
Punctuality, ability to be places at agreed-upon times _________
Responsibly able to articulate emotions or challenging sensations _________
Ability to admit mistakes and make them right w/o shame _________
Meet financial obligations on time with relative ease _________
Ability to be introspective without being “hard” on yourself _________
7. What 3 results would you commit to realizing in a coaching program – personal, business/career, etc.?
#1:
#2:
#3:
8. What patterns or personal shortcomings could potentially interfere with your or your organization’s success in a coaching program ?
9. Why should you be accepted into an Easy Way Success program?
BONUS: Priorities Assessment
Rank the following based on the amount of time and energy usually spent in these areas. (#1 is the where most time/energy is spent, #5 is the least)
Self: Exercise, rest, self-care, getting needs met _________
Relationship: Social life, partnership, dating , etc. _________
Career: Work, business, creating, etc. _________
Family: Kids, parents, siblings, et. al. _________
Friends: Relationships, fellowship, support, network _________
IDEAL SCENARIO
Describe the absolute best-case scenario for you (and your organization, if applicable) and the time-frame in which you’d like to have it happen.
Session Times (circle or bold preference): Morning Afternoon Evening
Program Preference* (circle or bold): Individual Group/Mastermind
*(Choosing here puts you under no obligation)
Home/Study Course
Seminar/Webinar
Name
Phone _
Business Name/Title
Email _
Email answers or download this Form here, fill out and send as an attachment to:
