Exploring the Career Transition:

Achieve Satisfaction, Meaning, and Success

Registration Form

Program: “Exploring the Career Transition: Achieve Satisfaction, Meaning, and Success

Dates/Time:Program runs from March through June 2014. For group coaching sessions, we will meet in person on Mondays from 6:30-8:00 pm (March 3, March 17, April 7, April 21, May 5, May 19, June 2, and June 16). Upcoming workshops are to be decided.

Location:Jack T Dean Academic Center at Grace Bible College, 2550 Rogers Lane, Wyoming, MI 49509

Program Fee:$675 for early-bird application by Friday, Feb. 7, 2014. After Feb. 7: $775.

Payments can be evenly split into 2 payments. Required non-refundable application fee of $150, which will be applied toward the first payment. First payment due by Feb. 21. Second payment due by Apr. 7.

Deadline:Only a few spots available, so apply now. Latest date to apply is February 21, 2014.

Details:One to two weeks prior to our first group coaching session, you will be sent a Welcome Packetand schedule.

While it is our hope that you land your new job or career before the end of the program, please understand that none of the fees can be reimbursed. The cost is for the program in its entirety. However, if you land your new job or career before February 21 (application deadline), we will reimburse all payments made, minus the $150 application fee. Thanks for understanding the nature of this kind of program!

Contact:Kimberly Gleason, Kimberly Gleason Coaching, 2305 Briar Hills Dr. NE, Grand Rapids, MI49505. . 616-364-7459

Registrant Information:

Name:

Address:

Email:

Home phone:Work phone:Cell phone:

(Choose One)I will be paying in one installment: ______I will be paying in 2 installments: ______

Questions:

  1. Are you currently employed? If so, where, and what is your position?
  1. What led you to register for this program?
  1. What do you want to get out of this program? Please list your top (3) objectives or goals.
  1. What do you think your biggest challenges will be?
  1. How motivated are you to achieve those goals and overcome the obstacles that stand in your way? What are you willing to do?
  1. How did you hear about this program?
  1. Is there anything else I should know about you or your situation?

Scan and save this completed form to your computer. Then send it via mail or email. Send your $150 deposit via mail (payable to Kimberly Gleason Coaching or through Paypal. If through Paypal, go to and click “Send Money.” You will need to use this email address: . Note: I cannot reserve your spot in this very limited group until I have received this registration form and your deposit.

I agree to the above terms: ______(signature)______(date)