1-to-1 Coaching & Mentoring

Executive Coaching

Initial interview form — Coach IanB

Please complete the following to help us jump-start the Executive Coaching process. All information is confidential.

Your details

Full name *

Company / organisation

Email *

Phone

Contact information

Address (City, Country)

Preferred date of interview

Tell me about yourself

Your age

Your family (brief description)

Your work history — summarise your career journey so far

Important personal relationships

Interests and hobbies

Your personal mission — and how your current role aligns (or doesn't)

Strengths & leadership

Your top 3–5 personal strengths (at work or in life)

Your top 3–5 leadership strengths — and how they relate to your personal strengths

Areas you can most improve as a leader — and what difference it would make

Previous assessments

Have you completed any leadership assessments? (e.g. DiSC, Myers-Briggs, Gallup StrengthsFinder)

Yes No

If yes, which assessments — results summary and what you learned about yourself

Greatest leadership challenge over the next 6–12 months — and how prepared you feel

Life balance wheel

Rate your current satisfaction 0 (none) to 10 (complete) for each area.

Career

Family & friends

Significant other

Fun & recreation

Health

Money

Physical environment

Personal growth

Skills to enhance through coaching

Select the leadership skills you would most like to develop.

Skills to develop

Values Purpose Vision Strategic planning Prioritization Managing time Work/life balance Productivity Coaching for performance Staff development Personal development Interpersonal skills Political savvy Teamwork Presentation skills

Other (please specify)

Why you want to focus on these skills

Previous coaching experience

Have you worked with an executive coach before? Describe the experience — positive or negative.

What from that experience would you like replicated in our relationship?

All information is confidential.