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Coaching for Success Form
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Coaching for Success Form
Coaching for Success
Please fill in the application form below.
Email
First Name
*
Surname
*
Enter your postcode (We only use this to track engagement across Scotland)
Your Email
*
Phone Number
*
Your current work status:
*
select
I am in full time employment
I am in part time employment
I am self employed
I am unemployed
I am on a career break
What sector do you currently work in or would like to return to:
*
Science
Engineering
IT
Built Environment
Other
What is the name of your highest qualification?
*
Are you currently studying?
*
No
Yes, part time
Yes, full time
Please state here any preliminary objectives you have for coaching, e.g. I am aiming to win a promotion at work in the next 12 months; I want to improve my work-life balance, etc.
Please choose two coaches in order of preference.
Coach 1
*
Sheila Anderson
Michele Armstrong
Derek Begg
Marie Kane
Karen Carlton
Duncan Coppock
Jody Dalzel-Job
Sam Pringle
Sophie Welch
Hazel Little
Coach 2
*
Sheila Anderson
Michele Armstrong
Derek Begg
Marie Kane
Karen Carlton
Duncan Coppock
Jody Dalzel-Job
Sam Pringle
Sophie Welch
Hazel Little
I agree to have my details added for newsletter and events information via email
*
Yes
No
I agree to have my details added for information on events via phone
*
Yes
No
I confirm that I have read the guidance and I meet all the eligibility criteria set out in paragraph 3 of the Coaching for Success Guidance Note
*
Yes
No
Equal opportunities monitoring questions -- How do you identify your gender?
*
Woman
Man
Other (including non-binary)
The Equality Act 2010 defines a disabled person as someone who has a mental or physical impairment that has a substantial and long-term adverse effect on their ability to carry our normal day-to-day activities. Do you consider yourself to be disabled as set out under the Equality Act 2010?
*
Yes
No
Which of these ethnic backgrounds do you consider you belong to (please select one option) ?
*
White English / Scottish / Welsh / Northern Irish / UK
White Irish
White Gypsy or Irish Traveller
Any other White background
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background
African
Caribbean
Any other Black/ African/ Caribbean background
Arab
Mixed ethnic background
Any other ethnic group
What age are you?
*
12 - 18
19 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65+
What is your religion or belief?
*
No religion
Jewish
Christian
Muslim
Buddhist
Sikh
Hindu
Other religion
What is your sexual orientation (please select one option) ?
*
Towards someone of the same sex (this covers gay men and lesbians)
Towards someone of a different sex (this covers heterosexual men and women)
Towards someone of the same sex and other opposite sex (this covers bisexual men and women)
Prefer not to say
Do you consider yourself to have caring responsibilities?
*
Yes
No
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