coachform

To Sign Up for the LIFELINE Coaching Program

The LIFELINE Coaching Program is designed to help employees reach their goal(s) in four (4) to six (6) sessions. The program is open to benefits eligible employees only, not family members. Participation is limited to 15 per month.

The registration process is quick and easy. After you have completed the "Are You Ready yo be Coached" questionaire, simply fill in the information requested below, and click Submit at the bottom of the page. Reservations are taken on a first- come, first-served basis. We need your address so we can mail you a book after you complete the first step. Your Coach will notify you by return e-mail or telephone call which month your sessions will begin.

Name:
Primary E-Mail:
Daytime Telephone Contact Number:
Street:
City:
State:
Zip:
Your coaching area of interest:

Requirements For Participating

Due to the popularity of this program, participation is limited. We ask all employees to commit to the following requirements in order to participate:

Commit to all Coaching sessions.
Complete several short coaching assignments. The coaching workbook will be provided by the LIFELINE Program.
Make the scheduled calls to the Coach. You will be responsible for the cost of the calls after the first contact.
Provide an evaluation of the program upon completion.

If you agree to these requirements and have completed the requested information click SUBMIT below to register.

If you have any questions regarding the registration process, please call us at 816-753-8283