EmailMe Form - Professional Accelerator for Forensic Scientists

I understand that this form MUST be completed by the student who will be participating in the Accelerator: *

Yes

I understand that my information will be kept confidential: *

Yes

Please select the official start date for the class you wish to register for *

For On Demand: Please select a Monday as your approximate desired start date:

MM / DD / YYYY

Participant Name: *

First Last

Participant Email: *

A copy of the information provided here will be sent to the above email address

Confirm Email:

Participant Nickname:

If other than your first name, how would you like to be addressed?

Employer: *

For what organization are you currently employed:

Years at current employer: *

Years in Forensic Science: *

Position/Job Title: *

Mobile Phone: *

### - ### - ####

Work Phone:

### - ### - ####

Mailing Address: *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Sex:

Marital Status: *

Number of Children: *

Which of the following best describes you, right now? *

Completed my forensic training recently

Completed my forensic training within the last two years

Completed my forensic training more than 2 years ago

What is(are) the primary reason(s) you are interested in the Professional Accelerator Program? *

Because I am interested in improving my professionalism and individual effectiveness

Because I feel that I'm not meeting my potential and want to change

Because I am preparing myself to take on more responsibility in the future

Because I am being compelled by a superior authority in my organization

Please select all that apply

You will learn from - and work with - a professional coach. What do you most hope to gain from this experience? *

What level of stress or pressure do you experience on a regular basis in your PERSONAL life? *

What level of stress or pressure do you experience on a regular basis in your PROFESSIONAL life? *

Do you care for an elderly person or someone with a serious illness or disability? *

In the last 12 months, have you had any disciplinary action taken against you by your employer? *

How often do you cope with feelings of frustration, anger, disappointment, or other negative feelings about your career or your current employer? *

Have you suffered any major loss or tragedy in the last two years? *

Funding Availability - Please advise on the status of funding available for this program: *

Personal Narratives

Please take just a few minutes to answer the following questions to help your coach learn more about you. You have a maximum of 100 words per answer. The information you provide significantly boosts the quality of your coaching session and will help your coach guide you toward your personal and professional goals.

How things are currently going for you in your career - what is going well and what do you wish was going a bit better? *

If you could change or improve anything about yourself, what would it be? *

What are your hopes and goals for the next five years? *

Please share anything else you would like to tell us about yourself or your goals:

Client Acknowledgements

Please carefully read the following acknowledgements and click yes to indicate your agreement

I understand that the information or opinions shared with me during this program do not compel me to take any specific action. Any decisions I make or actions I take are based solely on my own judgement and discretion. *

Yes

I understand that coaching is not a form of therapy or medical treatment: *

Yes

I understand that the value of coaching depends, in part, on my honesty, thoughtfulness, and the effort I put forth to communicate my coach and/or facilitator: *

Yes

I agree to tell my coach/facilitator if I ever feel like the program is frustrating or not helping me: *

Yes

Are you a graduate of our Professional Orientation School for New Forensic Scientists (POS)? *

Yes

No

If you are are a POS graduate, what month/year did your class begin?

MM / YY

Please select your registration type: *

Early ($1,695): To be paid prior to the start date

Late: ($1,850): To be paid after the start date

Please select your method of payment: *

Credit card

Check without a P.O.

Check with a P.O.

Will it be necessary for our office to register as a NEW vendor with your agency? *

No

Yes