Before submitting an application, please review the Licensee Qualifications.

If you are applying as a Qualified Coach, use the application below.

If you are applying as a Qualified Career Professional, use this application.

Qualified Coach Licensing Application

Contact Information:

Name:

Address:

City/State/Zip:

Country:


Postal Code:

Email Address:

Occupation:


Employer or Business Name:


Employer or Business Address:

City/State/Zip:

Country:


Postal Code:

Indicate below which of these four criteria you meet. Also fill in the relevant information pertaining to that criteria.

Certified by the ICF (International Coach Federation) at the Associate Certified Coach (ACC) level or above.

ICF Certification Level (For example: ACC, PCC, MCC):


Date certified:

Certified by the IAC (International Association of Coaches) and has logged a minimum of 100 coaching hours.

IAC Certification Level (IAC Certified Coach):


Date certified:

Graduated from a reputable School of Coaching and has logged a minimum of 100 coaching hours.

Indicate the School of Coaching you have graduated from:


Date graduated:

Graduated from a Coaching degree program offered by an accredited university or college and a minimum AND has logged a minimum of 100 coaching hours.

Indicate the university or college you have graduated from:


Date graduated:

Indicate the coaching specific degree that you have earned:

If called upon to do so, are you willing and able to provide documentation to verify that you meet the criteria that you have indicated above?
Yes   No

Additional Education: List all relevant post-secondary education including college or university degrees, graduate degrees and other relevant advanced training (include professional as well as academic instruction), beginning with the most recent. Include the name of the school or organization, the dates you were there, your focus of study, and your degree or certificate:

Current Occupation: Briefly describe your present occupation. (Your duties and responsibilities, whom you work with and/or for, etc.)

Work Experience: List any professional experience you have had in counseling, coaching, consulting, speaking, or teaching, or as a seminar or workshop leader, as well any specific experience you have had in the career field. Include years of experience and, if applicable, organizations you have worked with or for.

Organizations, Awards, and Honors: List the names and addresses of professional organizations to which you belong, as well as any professional or community service awards or honors you have received.

Motivation: What excites you about using these materials? Why do you feel that you are well suited for this work?

Goals: What are your primary goals in using these materials? What do you hope to accomplish?

Programs interested in: Please indicate the programs you want to license use of:

Zen and the Art of Finding the Work You Love
Zen and the Art of Career Empowerment

Intended use: Please indicate the PRIMARY way you intend to use the program materials:

Individual Career Coaching
Corporate Coaching
Career Consulting
Career Counseling
Seminars, Workshops
Classes
Other—Please indicate

Once licensed, where do you intend to provide these services?

City/State/Provence/Region/Country: