Intellect

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You are willing to attend:

Program Start :

Schedule of the coming round Dates and Times of the Sessions: (Monday - Wednesdays) 6:00PM - 10:00 PM CLT July 5 10 12 17 19 24 26 31 Aug 2 7 9 14 16 21 23 28 30 Sep 4 6 11

**Please note that Schedules are exposed to slight changes, In case of changes Participants will be notified not less than 72 hours before the start date of the program.

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Date of Birth:

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E-mail:

Education:

Work:

Have you been diagnosed with psychological or personality disorder in the past year?

Do you currently take any medications for your mental health?

How did you know about the course?

What are the main reasons for you to take this course?

In your own words- not what Google says, how would you describe coaching?

What is the outcome that you expect to come up with after completing the course?

What are the three biggest changes you want to make in your life over the next three years?

POTENTIAL & POSSIBILITY

What will personal success look like?

What would you like to contribute to the world?

What motivates you to do your very best?

On a scale of 1 to 10 (10= HIGH), rate the quality of your life today:

What Events, Seminars or Books Have You Attended, or Read Which Have Had the Most Impact On You?

I Have read and agreed the attached ACSTH program agreement

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