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Fill out this form to register for class enrollment or click here to download a printable version of this form (to be filled out and either mailed or returned by hand to Life Coaching Institute.)

NOTE: Please print the signature page found here and bring with you to the first class, even if you are completing the registration form online. Thank you.

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This application is divided into two parts.  The first part is a statement about your educational background, work experience and why you want to become a coach. The second part involves a description of the overall program and its policies and a listing of agreements that you agree to once you are enrolled in the coaching program. I. Statement of Purpose and Rationale for Wanting to be a Coach Please present a short concise statement of why you’d like to become a coach and your goal once you have become certified in this area. In your statement please include a background of your educational degrees and work experience including your present job. Statement of Purpose: II. General program vision,  goals. philosophy and intended participants for the Insight Transformation SM Coaching Program: Vision statement We are a life coaching school that focuses on achieving deep positive change for clients through accessing a mindful, positive mindset controlled by the parasympathetic nervous system and inspired intention.  We believe that the promotion of happiness, positive relationships, wisdom and the sacred within (as defined by the client) are a foundation for inspired living, optimal performance, excellent decision-making and problem solving, creative thinking, good health, and positive relationships. (This is supported by both neuroscience and psychological research.)  The emphasis on developing conscious control of this mindful positive mindset reflects a belief that transformational coaching (as described above) can produce the foundation for producing a powerful new paradigm for living and working. Program Goals 1.Understand and apply the framework for achieving deep positive change through accessing a mindful, positive mindset, Insight 2. Understand the contribution of neuropsychology, neurophysics and positive psychology in the development and principles of the Insight Transformation SM. model. 3. Display competencies that reflect those of the International Coaching Federation for coaches, as well as those specific to implementing the Insight Transformation SM model of life coaching. 4. Learn coaching skills and tools through rigorous academic training while at the same time applying that learning in 25 supervised coaching hours per class.  5.  Provide the client with knowledge of self-coaching tools that build inspired living and work, as well as tools that transform negative experiences acting as barriers to coaching goals.  6. Create a plan for developing and growing a small business (such as a coaching practice)   through using the Insight Transformation SM  process emphasizing a mindful, positive mindset for business decisions vs. a fear-driven one. 7. Provide a means of personal and professional development for students through assigned projects and exercises. 8. Provide two levels of coaching certification (basic and professional) reflective of the ICF ACC and PCC certification process. Concept/philosophy behind the program Many coaching programs are focused on behavioral change, rather than deep transformation. There is a place for both types of programs in coaching, but deep transformation is needed for certain desired goals in life coaching. Examples of this include goals aimed at achieving a closer relationship with the sacred, a positive relationship with a spouse, finding meaning in one’s life and work, finding balance in life and work, or becoming a presence based leader.  Secondly, there is a need for a deep transformation approach that uses a holistic approach that sees human change as part of an environmental-person system. Insight Transformation SM includes consideration for the human domains of spirit (as defined by the coachee), mind, emotion, subtle physical (energy of the body), physical (body based coaching tools and health considerations) and life context (interactions with those individuals and groups in your life).  Third, there is a need for a coaching framework that deliberately teaches self-coaching tools to clients to not only build positive opportunities and outcomes, but also for transforming the challenges of negative experiences/emotions that get in the way of what is desired. Finally, there is a need for more programs that provide a framework based on evidenced-based research, rather than primarily common sense. The Insight Transformation SM coaching program is an attempt to address these needs. Intended participants Intended participants include the following types: 1. Those with or without a college background who have a passion, talent and/or experience in empowering others to find and manifest what they really want through the use of genuine caring and intuitive understanding. 2. Those with a college degree in a helping profession (such as nursing, counseling, or teaching) who wish to increase their present skills to provide more effective helping services and/or diversify into the coaching field. 3. Those who wish to acquire deep personal change and growth or see themselves needing skills that will help them act as a positive change agent/leader for the future.   III. Policy Statements Policy statements regarding payment of tuition and fees Each participant has the option of paying in full at the beginning of each class or pay in three installments over the time of the class.  The intensive workshop part of each class must be paid for in full up front by those paying in installments. If a participant chooses to pay for the certification program in full, a 10% discount for the total will be offered.  To continue with the next class all fees must be paid in full. Policy statements about withdrawals and refunds  If a student chooses to drop out of the class, if they have paid for the class in full, they will be refunded according to the following schedule less $60 non-fundable deposit:   50% after attending the beginning intensive workshop up through session 1 30% after attending session 2 up through session 4 0% refund thereafter. For those paying in installments, the amount charged for each session of the class will be calculated and then a determination will be made as to whether money is owed the student or the student owes money to Life Coaching Institute.  The $60 non-refundable fee will be included in these calculations. For those paying for the program of certification classes in full, the schedule of refund is as follows less the deposit fee and calculated at the discounted amount of 10%:   No refund for each class completed For a class not completed and never started, the full refund of the tuition of the class will be given at the 10%. discounted amount.   For a class completed in part, the following schedule will be applied less the deposit fee:  50% after attending the beginning intensive workshop up through session 1, 30% after attending session 2 through 4, and 0% refund thereafter. Policy statements about student code of conduct Students are expected to treat each other with respect and to keep confidential personal information obtained in the program about their fellow students.  Additionally, each student is required to honor all elements of their contractual agreement regarding confidential information and proprietary material even if they withdraw from the program.  If the agreement is not honored, appropriate legal action will be taken. When coaching clients while studying to become a certified coach, all students are expected to obtain their professional liability insurance, keep client records according to the format provided, keep confidential information provided to them by the client, and otherwise conduct themselves in a professional manner. IV. Agreements Pre-requisite to Attending Coaching Classes I understand that I will have to have 6 hours of personal coaching prior to attending class.  I realize that this experience will help me understand what coaching is from the client point of view, as well as provide a good foundation for learning. These 6 hours are preferably done using the Life Coaching Institute model of coaching, but could be obtained from any certified coach. Deposit I understand that I must include a $60 deposit with this application that is non-refundable. This amount will be applied toward the tuition for any class for which I sign up. Tuition I agree to pay the stated tuition for each coaching class I take by the date agreed on and in the manner described in the policy statement “payment of tuition and fees”.  I have also read the stated policies about tuition reimbursement and understand them. Contact LCI office manager Jerry Greyierbiehl to arrange for installment payments. Class  Completion I understand that I must complete and satisfy all requirements of any pre-requisite classes prior to advancing to the next class. I understand that classes will be considered incomplete if I miss more than one session unless the session is made up. I agree to pay the regular coaching fee for a made-up session.  Certification as a Coach I understand that to become a certified coach there are two possible levels of certification as described below. To become a certified coach I realize I must complete at least the basic certification level.    Basic certification:  72 hours of classroom training (3 classes) and 75 hours of coaching clients (25 hours each class). Only 20% of these hours can be pro-bono. Completion of a minimum10 hours working with a mentor coach is also required (This requirement is fulfilled by the credentials of the teacher and supervisor in each class.)  Once completed, you will be certified as a coach at the basic level. This will provide credentials for starting your own coaching business and stating you are a certified coach. You will also be eligible to apply for national certification from the International Coach Federation (ICF) if desired. For the ICF certification at the Associate Certified Coach level you will need the following: 1. successful completion of a 30 minute oral examination with an ICF examiner, 2. signatures of two PCC or MCC certified coaches attesting to your competence as a coach determined by listening to a specified number of recorded sessions, 3. completion of 100 coaching hours submitted on the specified ICF form, 4. a letter from your coach training school summarizing the class content and the number of classroom contact hours successfully completed. 5. completion of the academic training form provided by ICF listing the class and their content (for those not trained in an ICF accredited school) 6. completion of  the ICF log form indicating a minimum of 10 hours of mentoring by a PCC or MCC certified coach. Please refer to the ACC portfolio certification directions provided by ICF for verification or any change of the above requirements and detailed directions for filling out their on-line forms.   Professional certification: 125 hours of classroom training is required. (You can include the hours already obtained at the basic level of certification; that means you’d need 53 more hours in training to achieve the total amount needed).  325 hours of client coaching are also required (you can include the 100 hours obtained at your basic level). A minimum of 10 hours of mentor coaching is the final requirement. As with the basic level, you will be eligible to apply for national certification from ICF for the Professional Certified Coach credential upon completion of their additional requirements for this level.     Intellectual Property The Insight Transformation SM  model and its process components such as Insight Communication, Creating, the Empowered Self, the Operating Self , Inspired Living and the Insight Transformation SM Business Process are the sole intellectual property of Life Coaching Institute (LCI) and Dr. Dianne Greyerbiehl. Techniques, processes, materials, presentations, handouts and training activities, as well as the company name and the corporate logo are exclusively owned, service marked and copyrighted by LCI. As a certified coach of Life Coaching Institute, I understand that I can use the above intellectual property in a coaching capacity.  However, use of this intellectual property can be used only if there is clear credit given to Life Coaching Institute and Dr. Greyerbiehl as the owner and creator of this approach and material. Permission must be obtained to use any of said intellectual property for any purpose beyond the normal coaching situation such as for written or oral presentations and teaching situations. Confidential Information While doing coaching, I understand that all information obtained by me about a client will be held confidential except for discussing said client with an appropriate supervisor. When presenting clients in class I will avoid saying the clients name to maintain confidentiality. All records obtained from coaching clients will be maintained properly and securely and I will not disclose confidential information from these records to third parties without written permission from the client. Liability Insurance Once I start coaching with paying clients, I understand that I will be expected to obtain liability insurance for myself. General Code of Conduct I have read the policy statement on student code of conduct and agree to abide by that conduct. Signature By signing this document I am indicating that I have completed the first page of information without misrepresentation of my background and desire to be a coach.  I also am indicating that I understand the school’s vision, goals, policies and agreements and am promising to abide by such policies and agreements.
	By checking the box and typing your name in the box below, you have verified the information supplied and agree to the terms above.