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Beyond Burnout Group Coaching Program Application

Welcome!

Thank you for your interest in the Beyond Burnout Group Coaching Program. This program is designed to help female physicians in academia achieve greater career and personal fulfillment.

Please answer the following screening questions:

What is your full name?

What is your email?

What is your phone number?

Are you a female doctor (MD, MBBS, DO, PhD, DPM) currently working at an university-affiliated medical center?

Yes

Which of the following describes your experience with coaching?

Please check all that apply

I have worked 1:1 with a coach before.

I have participated in a group coaching program before.

I know what coaching is, but have never worked with a coach before.

I am new to coaching and not sure how coaching is different from mentoring or advising.

Current situation:

Briefly describe your current work situation and the biggest challenge you are facing.

What are your goals for your career and personal life?

Where do you see yourself in the next 3-5 years?

In the past year, how much have you invested in your personal development?

What is your long-term vision for your career?

What are your expectations for the Beyond Burnout Program?

If there were ONE thing you could achieve or receive from this program, what would it be?

What else are you hoping to achieve by participating in this program?

Beyond Burnout is a 12-week commitment. Are you able to dedicate the necessary time and effort (2-3hrs/week) to participate fully in the program?

Yes

On a scale of 1-5, how committed are you to joining the Beyond Burnout Group Coaching Program?

The investment for Beyond Burnout is $3000? Are you prepared to make this investment in yourself and your career?

Note this is the first and only time the program will be offered at such a discounted price.

Yes

Is there anything else you would like to share about yourself or your interest in this program?

Submission of this form is neither formal acceptance into the Beyond Burnout, nor an obligation to join. Once your application has been reviewed, we will be in touch with next steps.

I AGREE