PODCAST APPLICATION

Thank you for your interest in a leadership coaching session with Muriel Wilkins for the Coaching Real Leaders podcast.

Please provide the following information and answer the questions as thoroughly as possible. We ask for your personal information below for contact purposes only. The information you share is confidential and if you are picked to be on the podcast, we will use an alias for you and not your real name.

Let’s get started!

Date *

First Name *

Last Name *

Phone Number *

E-mail Address *

Gender *

Female

Male

Non-Binary

Other

Contact Preference *

E-mail

Phone

Ethnicity/Nationality *

City/Town/State of residence *

Age *

What kind of organization do you work in? (Please do not name your company -- just your industry and rough size of your organization is helpful) *

What is your title and what type of work do you do? What is your current role in the organization, both formally and informally? *

Why are you interested in a coaching session with Muriel? Please be as specific as you can. *

Tell us about the specific issue you are hoping to get guidance on. What are the internal and external factors contributing? Are there any stories or examples to illustrate the problem (withholding any identifying names of colleagues or your company). *

What are you hoping to get out of the coaching session with Muriel? What is your goal? *

Anything else we should know about you and your work life that will help us understand you better?

Thank you for your interest in joining Muriel on Coaching Real Leaders. If there is a good fit, we will be in contact with you for a brief interview, with the potential to be selected for a coaching conversation for a future podcast episode.

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