COI Coaching Form

Mark Divine Captains of Industry Coaching: Application

Thank you for your interest in becoming a part of the COI Coaching cohort with Mark Divine. Please note that the tuition for each cohort is $25,000 for the four month intensive program. We run cohorts three times a year and are selective with the group to ensure the dynamic is extremely productive. We will reach out to propose an interview date/time.

1. First and Last Name*

2. Email*

example@example.com

3. Linked In

4. Company/Organization Name

5. Web Site*

6. Title*

7. Phone*

Organization Annual Revenue

Number of Employees in Organization

10. List any leadership development programs you have participated in

11. Primary reason(s) for applying to the COI cohort

12. What are you hoping to get out of coaching?

13. Anything else you want to share?