EWN Survey | eWomenNetwork
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Premier Success Coach 2026 Application

First Name:

Last Name:

Company:

Address:

City:

State/Province:

Zip/Postal Code:

Phone Number:

Email Address:

Website:

Facebook URL:

Twitter Handle:

2. Are you currently a member of eWomenNetwork? (Note: you are required to be a member of eWomenNetwork)

3. Please list any coaching certifications from accredited coaching organizations or universities.

4. If you are an eWomenNetwork member, what Chapter city do you currently attend?

5. Have you performed at least 100 hours of coaching for clients?

Other (please specify)

6. Tell us about your background and your coaching experience.

7. Do you have an area or coaching niche that you specialize in?

If yes, please explain your area of coaching specialization:

In 3-5 words describe your coaching niche.

8. Please provide a brief explanation for why you want to be considered as a Premier Success Coach of eWomenNetwork.

9. What percentage (%) increase in new coaching business would you like to see?

Other (please explain)

10. Please check all that apply to you below:

11. Did someone recommend that you apply to become a Premier Success Coach?

If yes, please provide their name:

12. Please select which payment structure you would like to use for this program:

Comments:

13. Please complete credit card information for the PSC marketing program. (Note: you will not be billed until you are selected and confirmed as a Premier Success Coach.)

Name:

Name as is appears on Credit Card:

Credit Card Billing Address:

City:

State/Province:

Postal Code:

Cell Phone Number:

Email Address:

Credit Card Type:

Credit Card Number:

Expiration Date:

Credit Card Security Code:

PLEASE PROVIDE THREE (3) COACHING CLIENT REFERENCES:

15. Reference #1:

Name:

City:

State/Province:

Email Address:

Phone Number:

16. Reference #2:

Name:

City:

State/Province:

Email Address:

Phone Number:

17. Reference #3:

Name:

City:

State/Province:

Email Address:

Phone Number:

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