Application for Health Coach Certification

Course material submission

Date
MM slash DD slash YYYY

(MM/DD/YYYY)
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Special Circumstances for Scholarship Consideration
What financial need do you have for a scholarship?*
What contributions have you made in your field?*
Anything you'd like to share.
Max. file size: 512 MB.
How much time do you have to spend per week on your education and implementation?*

(This program averages a required amount of 20 hours a week. If you cannot set aside 20 hours per week, you will want to wait to apply until you are able to)
Are you currently a health coach?*
- Yes
- No
Educational Background*
Work Experience*
Why do you want to be a health coach?*
What are your long term career goals?*
What are you really good at?*
What are you really bad at?*
What will you do once you are a health coach?*
Time Zone*
Agreement*
- In return for acceptance into the Free Program by Health Coach University, Health Coach Certification program, I agree to offer thorough, honest and constructive feedback on all aspects of the course. I also promise to: 1. participate in 90% of group participation 2. 90% of weekly 1 hour small group meetings 3. Facilitate 25% of my weekly group meetings 4. Complete the final assessment for testing purposes.

Special Circumstances for Scholarship Consideration