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Worksheet

Somatic Leadership Coaching Application

INTERESTED IN SOMATIC LEADERSHIP COACHING WITH ALEXIS?

We just have a few questions for you to make sure we're the right fit!


1. ➜

Thank you for your interest in our Somatic Leadership Coaching program. The questions in this application are designed to help us understand your goals, challenges, and leadership journey. Please note that completing this application does not guarantee acceptance into the program. We carefully review each submission to determine if the program is the best fit for your needs and leadership aspirations. Our goal is to ensure this transformative experience aligns with your readiness and objectives. We appreciate your time and honesty in answering these questions and look forward to learning more about you!

2. ➜

What is your full name?

3. ➜

What is your preferred email address?

4. ➜

What is your cell phone number?

5. ➜

What is the URL of your personal Linkedin profile?

6. ➜

Do you work in higher education?

7. ➜

Which best describes you?

8. ➜

If you were to find the perfect recipe to help reduce cumulative stress so that you can continue doing what you love, even though it is demanding, are you in a position to invest in your health career?

9. ➜

Please share more detail below about the problem you aim to solve for your overall stress and/or burnout, and the impact you will create if you can manage your stress more effectively.

10. ➜

Let's Make Sure You Are Human. What is 7+7...?

11. ➜

How did you hear about us?

12. ➜

What is your position?

13. ➜

Are you on a tenure track?

14. ➜

Are you working towards a doctoral degree? If so, what year are you in?

15. ➜

If not in higher education, what type of work do you do?

16. ➜

How would you describe the pace at your current place of employment? (fast, slow, moderate, insane) What do you think about that pace?

17. ➜

Are you on Family and Medical Leave due to stress, mental health, or chronic illness, or did you just complete a leave, or are you contemplating leave?

18. ➜

Do you have a current therapist? If so, how often do you schedule appointments?

19. ➜

When was your last visit to your general practitioner for diagnostic blood work?

20. ➜

Currently, how many leave days do you have?

21. ➜

When was the last time you took a vacation without including work tasks and duties…

22. ➜

When you think about your future self in 30 days, what would you like to be different as a result of this somatic coaching?