Application

This is the application for you to be considered to join the Heart Coach Institute course to earn your Heart Centered Life Coaching Certificate.

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Step 1 of 7

Name*

Email*

Phone Number*

Address*

Username*

Password*

I am over 18-years of age*

Yes

	Very untrue of me	Somewhat untrue of me	Neutral	Somewhat true of me	Very true of me
Committed to your personal growth
In love with helping others
Good at listening to others
Able to practice tough love
Observant

	Yes	No
Attending all 22 online classes (2 hours per class)
Completing homework and practice skills outside of class (1-2 hours per class)
Working with a peer accountability partner (fellow program participant)
Maintaining confidentiality with fellow participants

	Yes	No
Have a positive attitude in class
Work well with other students
Coaching live in class to receive feedback and instruction
Being coached by a peer coach in front of the class?