Suffolk Coaching and Mentoring Partnership

Register as a coachee

To register as a coachee, please complete this form, filling in the requested information or ticking the boxes. The more information you provide, the easier it will be for us to match you to the right coach.

To move between sections, click 'Next' or the required tab. When you have completed all sections, please click 'Submit my application now'.

nb. please do not use your browser's 'Back' and 'Forward' buttons, otherwise you may lose information that you have entered.

About you

Please tell us some details about yourself.

* denotes a required field

Title  
First name *
Last name *
Job title *
Organisation *
Sub-organisation
Organisation address *


Town *
County / region *
Postcode *
Telephone number *
Alternative telephone number
Preferred e-mail address *
Your profile photo (optional) Please browse to your photo file (82 x 82 pixels for optimum display, otherwise your photo will be automatically resized).
Manager agreement *
Consent to storage and use of your personal data *
Coaching and / or Mentoring?

Objectives

Please tell us what you are hoping to achieve from your coaching.

* denotes a required field

Any specific coaching requirements: This information will be made available to potential coaches to help them decide whether they would be well placed to coach you.
My current position: (please tick all that apply) *



I require a coach to work with me to assist with the following: *

Logistics

Please tell us how you would prefer your coaching to work in practice.

* denotes a required field

I am willing to enter into a coaching relationship that is: (please tick all that apply) *

I would prefer my coach to be based within the following geographical area: *







I would prefer my coaching to take place via: *

Equality monitoring

The following questions are for equality monitoring purposes only, and the information provided will not be made available to other users:

Are you: *

What is your age group? *


What is your ethnic group? *















Please indicate your religion or belief *








Please indicate which term would best describe your sexual orientation *



Do you have a disability? *
A disabled person is defined in the Disability Discrimination Act as someone with a physical or mental impairment that has a substantial and long term impact on their ability to carry out day-to-day activities

If you answered yes, and would like to, please indicate the nature of your disability (tick as many as are applicable)








Other, please specify:  

 

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