Coaching Intake Form

Your Name*
First Last
Gender*
Spouse's First Name (if applicable)
Date of Birth
MM slash DD slash YYYY
Phone
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Have you taken the Grip-Birkman (GB)?*
The Grip-Birkman is a behavioral and spiritual Gifts assessment looking at three primary questions: Where am I strong? Where am I weak? and Who do I need? This in-depth tool provides new insight into how the natural behavior interacts with the supernatural empowerment of God. The focus of this assessment is how one can powerfully play their God-designed role in the Body of Christ most effectively.
Church Name*
Please type in the FULL NAME of the church/organization where you work. (i.e. Highland Oaks Church of Christ)
Your Position on Staff*
What date did you start this position?*
MM slash DD slash YYYY
What would be helpful for us to know about your current ministry context prior to our first coaching session? Where are you emotionally? What frustrations are you facing? What would you most like to gain from your coaching sessions?*

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