Opt-in: Speaker/Coach Application

Student Name *

Age *

Parent Name (if Student is under 18)

Phone *

Email *

Address *
City *
State *
Zip *

What specific outcome do you hope to achieve through speaking coaching? *

How committed are you to achieving these results (on a scale from 1 to 10 with 10 being extremely committed). *

My biggest strengths while speaking are: *

Please rate the following statements on how true they feel to you by typing in a scale from 1 to 5.

1 = Not at all true

2 = Rarely True

3 = Sometimes True

4 = Frequently True

5 = Always True

I am a dynamic and engaging speaker when I present *

I love the sound of my voice. *

I am very comfortable with my body and movement in front of an audience. *

I always know where I'm going and what comes next in my presentations/speeches. *

My voice never gets tired and sounds the same in the morning as it does in the evening. *

I am able to speak loudly when I need to and to adjust my volume at will. *

I am very good at converting speaking gigs/sales conversations into new clients. *

I am a confident speaker in any situation. *

Words just roll off my tongue and I rarely say fillers like "uh" or "umm". *

I can think on my feet and shift the conversation easily based on the feedback I'm receiving (whether one person or a large group). *

I have a warmup routine that prepares me for any conversation or speaking engagement. *

Are there any other skills not listed that you would love to learn? *

What have you tried in the last couple years to work on your speaking skills? *

To save us time and so I can best serve you, please take this 90-second personality assessment at bankcode.com/stephanie/whitepaper. After you shuffle the 4 cards on the screen and hit submit, you will be asked to confirm your email and will receive a copy of the whitepaper describing the science behind this methodology. I will receive a copy of your personality report (and you will also receive a copy). This will allow me to better understand your communication style and focus on what is most important to you.

How did you hear about The Empowered Performer?