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College of Executive Coaching
CERTIFICATION
APPLICATION
FORM Coach Certification Program (Print and Mail or Fax this Form) Application Procedure: Acceptance into the College
of Executive Coaching Certification Program is based on an examination of your
educational background and work history as well as your current situation.
Additional admission factors may include observation of your
participation in the initial coach training workshops and possible informal
interviews. Appropriate applicants
will have demonstrated significant responsibility in their professional life.
Enrollment is limited, so early application is recommended. Please complete this form, and return it to the College of Executive
Coaching Office. Please attach a resume, a photograph and the application fee of
$100. Admission Requirements:
Name___________________________________________________________________ Mailing Address_________________________________City____________State_____Zip_____ Home Phone _____________________Work Phone______________________________
Email______________________________ Website____________________________ How did you hear about this program?________________________________________________________________ List Most Relevant College/Advanced Training beginning with the most
recent: School or Training Inst.
Dates Focus
of Learning
Certificate or Degree
Describe your current work and title: List relevant work experience beginning with your present position: Dates
Setting
Position
& Responsibilities
I took my first course with you on this approximate
date (month/year): ____________ in this location (city/state):
_________________. What activities or events in your life have helped to prepare you for coaching? _______________________________________________________________
__________________________________________________________________________________ How would you describe your personal qualities that support your
transition to becoming a coach at this time: ____________________________________________________________________________
List your particular niche ideas for your coaching practice: ___________________________________________________________________________
Disciplinary Action: To be completed by all applicants: __ Yes __ No Has any licensing board
or other regulatory body ever taken any disciplinary action against you or a
license/registration held by you? __ Yes __ No Has any professional
association's Ethics Committee ever taken any action against you or your
membership as a result of an ethical complaint? If yes to either question, please attach a complete explanation. Be
sure to specify names and dates where appropriate. Approximately when do you hope to have finished the 72-hour training
program and documented 50 hours of coaching experience:___________________________________
______________________________________________________________________________
Agreement: I agree to abide by the Ethical Standards of my
professional associations and the International Coach Federation. Ideal applicants will have had significant
professional experience. The
ability to process complex information and “think on one’s feet” is
essential. As space can be limited
in our program early application is advised.
Most, but not all, applicants who meet our educational requirements, will
be accepted into our certification program.
Occasionally, and only in unusual circumstances, a student has attended
our program, but has not demonstrated a typical level of professionalism that
characterizes our student body. In
a case such as that our education committee would meet to discuss the student's
observed performance in our program, and the student may receive a
recommendation that another program would be a better fit.
In that case, the student would not be able to continue in our program,
no tuition paid would be refunded for classes already completed, but the courses
completed would still count towards certification with the International Coach
Federation Portfolio Certification Application. To the extent possible, student records are kept confidential, unless
release is required by law. However, a requirement of ICF Accreditation is that
an authorized ICF auditor has the permission to review files, classes, faculty,
student records, as well as interviewing students and staff. I hereby give
consent to allow records to be reviewed upon request of an authorized ICF
Auditor, ICF Reviewer or the ICF Application Review Committee. I agree that email addresses and contact information of other students that are provided for the purposes of completing collaborative homework assignments are only to be used for the purpose of completing class projects and not for any other use unless specific permission is individually requested and granted from the individual student. I agree to respect the intellectual property of others and to follow professional standards in terms of citing other individuals' work. I understand that violation of these principles may lead to dismissal from the certification program or revocation of certification. Applicant Name (printed): ___________________________
Applicant Signature: ___________________________
Application Date: _____________ Pease send the completed application with the $100 application fee
(refundable less a $30.00 processing fee if for any reason the application is
not accepted) and a photograph (unless previously submitted) to: College of Executive Coaching 897 Oak Park Boulevard, #271 Pismo Beach, CA 93449 USA +1 (805) 474-4124 Voice +1 (805) 474-5628 Fax
www.executivecoachcollege.com □ VISA □
MasterCard □
American Express
□
Check (Payable to College of Executive Coaching) Amount: $100.00 Application
Fee Credit Card Number: _____________________________________
Exp. Date ________ Applicant
Signature: ___________________________
Date: _____________ |
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