High Performance Coaching™
Pre-program application form

Please respond to the following questions so we can determine whether the High Performance Coaching Program is appropriate for you:

Your Current Situation
1.	I have a written plan for my business and other aspects of my life.	yes no
2.	I have increased by income steadily over the last five years.	yes no
3.	My personal income for the last 12 months was
4.	I currently demonstrate focus, organization, and productivity.	yes no
5.	I maintain a balanced lifestyle including work, recreation, and family.	yes no
6.	I work each day toward clear objectives for personal development.	yes no
Your Intentions
1.	What amount do you intend to be earning annually in 5 years?
2.	What do you see your net worth being in 5 years?
3.	What increase in your annual income do you intend next year?
4.	What additional professional skills are required for you to succeed?
5.	How much work time per week would you like to shift to recreation?
6.	What qualifies you as a promising candidate for High Performance Coaching?
Please provide your contact information, so we can inform you of next steps. Your Name: Company: Address: City: State: Zip: Day Phone: Fax: Email: