Coaching Program Registration Program

Coaching Program Registration Program

Thank you for your interest in participating in the Coach Training for Healthcare Leaders Program. Please complete this registration form regarding your interest, skills and experience.
Name

First Name Last Name
Email*
example@example.com
Primary Department*
Faculty Title*
Coaching Experience (select all that apply)*

NoneInformal coaching within BCM or Affiliated InstitutionsInformal coaching outside of BCM or Affiliated InstitutionsFormal coaching within BCM or Affiliated InstitutionsFormal coaching outside of BCM or Affiliated InstitutionsInternational Coach Federation (ICF) credentialed coachCredentialed through another coaching organizationCurrent enrollment in a formal coaching or mentoring programOther Training
If Other Training (Please provide a brief description of training):
Areas in which you are currently or interested in coaching others (select all that apply):*

Professional Identity Development: focus is self-assessment, goal-setting, growth, and general personal developmentProfessional Skills: focus is helping the individual accurately reflect on their performance, gain insight into desired outcomes, and needs for growth.Career Advancement: focus is self assessment, goal setting, and skills acquisition for promotion or leadership opportunities.Team and Interpersonal: focus is on developing management skills, such as human resources, team dynamics, and communication.Leadership Development: focus is on developing leadership skills in preparation for a leadership role.Business & Executive Development: focus is on facilitating successful unit leadership for an individual with an executive role and providing guidance for specific challenges in the role.Wellness and Resilience: focus is fostering wellness behaviors, work-life integration, and development of resilience.Team Effectiveness: focus is on coaching teams or groups with goal of increased effectiveness.
Category of Individual you are currently coaching or interested in coaching (select all that apply):*

Graduate students (Masters, Ph.D.)Professional Students (M.D., PA, DNP, OT, etc)Residents (Clinical)Fellows (Clinical)Post-docs (Ph.D.)Early Career FacultyMid-career FacultySenior FacultyStaffOther
How much time would you to spend coaching in your professional role?*
Please provide any additional information that you would like us to know in the space provided below:
Thank you for your interest in the coaching program. Decisions on applicants will be communicated no later than July 1, 2022
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