Registration - Bhavana Learning Group

Name*
First Last
Who referred you to this program?*
Other Referral
Please list who referred you to this program
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Local Time Zone*
Phone Number*
Email*
DOB*
Month
Day
Year

Gender*
Race/Ethnicity*
I Identify as...
Company*
Company Website*
Role/Position/Title*
Education Level*
Program Criteria*
Please choose one of the following applies to you.
- Experienced Coach - Minimum of 200 hours of coaching experience in any of these areas: an external coach, internal coach, coach trainer, or mentor-coach
- Educators and Learning Professionals - experience as a trainer or program manager with previous self-development experience in leadership development or listening, and being in a coaching relationship with an executive coach for at least 50 hours.
- Executives – extensive self-development (through an experiential program) in leadership development or personal mastery; or the experience of being in a coaching relationship with an executive coach for at least 50 hours (with participation in a 360 evaluation).
How many years have you coached with clients?*
How many years have you taught in a classroom?*
How many years have you managed others?*

Question #1*
What’s your intention for this program? Begin with the reason you are engaging this learning, and establish an intention for this program.
Question #2*
List a specific obstacle or impediment to listening that you’d like to resolve in this program? Be specific and offer an example.

PAUSE HERE: Please Capture or Schedule these dates:
Program Dates: Sept. 20, 27 | Oct 4, 11, 18, 25 | Nov 8, 15, 22, 29 | Dec 6, at 1-3 pm (ET)
Practice Workshop Dates: Choose 1 of 3 of these Fridays to schedule 10/15, 10/29, or 11/12, at 2-3:00 pm (ET)