A-Squared LAMP Groups - Pay-It-Forward Scholarship Wait List

Pay-It-Forward Scholarship Wait List - Susan Zytnik-Künzler

We will provide a Pay-It-Forward Scholarship packet, 3 coaching sessions, any needed assessments, email or phone support, and guidance as you progress toward your chosen area of success.
Please describe your need for coaching. Indicate what areas you may feel stuck in, any area you would like to improve or be more successful in, and/or what you would like to focus on during our coaching sessions with you. *
Your Full Name.	*
Your Email Address	*
Your Full Mailing Address.	*
Home Phone Number.	*
Mobile Phone Number.	*
For survey purposes only (it will be anonymous and does not affect your selection on the wait list), please indicate your current annual family income range.	*
To keep our Pay-It-Forward community chain strong and intact, we ask you to consider and answer these statements.
I will respect those who invested in my coaching experience and will actively participate in the coaching process and toward my own goal completion.	*
I understand that I will need to do personal work outside of the coaching sessions in order to achieve my goals.	*
I understand that my participation in this Pay-It-Forward Scholarship involves communicating my own experience with coaching to others, but that no details of my coaching experience will be shared without my express permission.	*
I agree to attend one A-Squared LAMP Groups annual event and be introduced to other Pay-It-Forward recipients or contributors (remote or prerecorded options).	*
As a Pay-It-Forward Scholarship recipient, I will be required to send a Thank-You card to the former recipient who provided funding to me and a Welcome card to the next recipient who will benefit from my pay-it-forward contribution. I agree to do this in a timely manner.	*
I understand that the Pay-It-Forward Scholarship $ amount I receive in services is paid for by the previous scholarship recipient and will be paid forward to the next scholarship recipient by me within the agreed-upon time-frame. I understand that I have up to a year after my services are completed to make my donations forward.	*
I understand that once I am notified that this application is approved, I will reaffirm my comitment to the scholarship terms and begin my coaching experience.	*
I understand that I will be given information on hosting a mini-fundraiser with family and friends to assist me in raising my pay-it-forward contribution. I understand that I can donate myself to pay-it-forward or ask others to contribute.	*
I agree to complete a service evaluation form and submit it to the organization within a week after my final coaching session.	*
Please type in the box to the right »	*