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. ➜

How did you hear about us?

7. ➜

Do you work in higher education?

Yes

8. ➜

What is your career and position? Would you consider this high demand for you? If so, what makes it high demand?

9. ➜

How would you describe the pace at your current place of employment? (fast, slow, moderate, insane) Is this a well-suited pace for you?

10. ➜

Which best describes you?

I am just starting my career, I'm burnout/stressed, and I am not sure how to continue working at this pace

I have been working for some time, and been burnout for some time, it is time to change

All that I know is that I have to fight to get up every morning - I just feel done!

I am ambitious about my goals, believe I can continue with my career, and managing right now, I just need more skills to avoid burnout

Other

11. ➜

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?

Yes, I have access and can prioritize my health in this way

Maybe, I have to access credit and can be resourceful

No, I have no capital, access to credit, and it is hard to prioritize time off

Other

12. ➜

Please share more details 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.

13. ➜

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

14. ➜

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

15. ➜

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

16. ➜

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

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