APPLICATION FORM

Complete the application below.
We will contact you after revising your application to book an introductory session with Vashti.
If you are applying for the scholarship program, please click yes to that option.

*Please know that there are limited spots in the coaching programs.

First name

Last name

Phone

Position

What are the 3 specific things you would most like to gain from being coached?

Describe where you believe that you are thriving most in life right now?

Describe the 3 areas that you feel most stopped and blocked personally and professionally?

What are the 3 things you would most like to accomplish over the next 24 months?

What are the 3 words you would use to describe your best self?

What are the 3 words you would use to describe your worst self?

What are you most proud of in your life so far?

What or where do you feel a sense of regret, disappointment or loss in your life?

What do you hope to gain from working specifically with Vashti?

What are the 3 habits that you would most like to change?

What are 3 things that you are most passionate about?

Is there anything you would like to add?

Have you been coached before?

Yes

Are you currently taking any medication to assist with your mental health?

Yes