Graduate Coaching Student Application

Franklin University Graduate Coaching Programs – Student Application

This form provides the coach with information that will enhance the coaching relationship. Please provide the following information to help identify and achieve your coaching goals.

Full Name:

City: State:

Email:

Preferred Phone:

Name of employer (if applicable):

Position/title:

Duration:

Duties:

In 3-4 sentences, please summarize your prior work and educational experiences:

What degree(s) and/or certification(s) do you have?:

	Degree/ Certification	College/University	Major	Year Obtained
1.
2.
3.

What are the primary reasons you want to enter into a coaching relationship at this time?:

How would you rank your current level of satisfaction with your current/ most recent job?:

	Very Satisfied
	Satisfied
	Dissatisfied
	Very Dissatisfied

What was your greatest success in the past year?:

Choose an area or areas you’d like to focus on in your coaching:

	Skills, interests and values identification
	Career planning
	Job market information and feedback
	Interviewing
	Relationship building/networking
	Communication
	Work, life and school balance
	Other

What is your biggest challenge right now? Or, to put it another way, what factors are holding you back from having everything you want in your professional career?:

What are your most important goals for the next six months?:
1.
2.
3.

How did you hear about Franklin’s Coaching Programs?:

	Franklin University website
	Received an email
	Attended a course or presentation where it was mentioned
	Printed material (flyer/brochure)
	Franklin faculty member
	Franklin student/alumni
	Other

Note: Our coaching relationship is confidential. Unless you disclose issues that your coach is required to disclose to the authorities (e.g., intent to harm yourself or others), all of the content of your conversations will be held in confidence.

Is this confidentiality policy acceptable to you?:

Yes No