Intake Form Leadership Coaching Name(Required) First Last Email(Required) Enter Email Confirm Email Phone Number What do you hope a coach will help do for you? Clarify your career/work goals? Improve your current work situation? Work on stress reduction and self care Make a “graceful and productive” exit from work? Reduce obstacles and barriers to moving ahead in your personal pursuits Select AllHow long have you been in the work force? Less than a year 1-3 years 3-5 years 5-10 years 10 or more years In a few words explain what your desired outcome from a coaching partnership would be.In a few sentences, tell me about yourself, your job, where you work and what you do.If you could project out 1 year, what would be your ideal situation?What current challenges do you think may be preventing you from achieving your goals and desired outcome?Why have you specifically decided to reach out to Shane?NameThis field is for validation purposes and should be left unchanged.