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Palm Beach State College
IEECE
Life Skills Coaching - Individual Intake Form
Life Skills Coaching - Individual Intake Form
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First Name
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Last Name
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Registry Number
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Email
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Phone
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What do you hope to gain from our coaching sessions? Please be as specific as possible. Example: “I want to learn better time management skills so that I get more done and do not feel as overwhelmed or tired.”
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List your top 3 strengths:
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List 3 areas you would like to grow:
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Rate your current level of stress in your life on a scale of 1-10, 1 being you are not at all stressed, 10 being you are extremely stressed:
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10
Please list what days and times work best for you to meet with a coach, as well as if you prefer phone, zoom, or in-person meetings.
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