Satir Coaching Certification Program Application

Please complete the following form to apply and be considered for the upcoming Satir Coaching & Mentoring Certification Program.

**All applications must be submitted no later than August 1, 2025 to be considered for this program

Name

First Name

Last Name

Preferred Pronouns

Phone Number

Country

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How did you hear about the Satir Coaching & Mentoring Certification Program? If you referred to this program by a trainer, please include their name.

Briefly describe why you want to attend this program and become a Satir Coach & Mentor.

What do you hope to take away from your involvement in this program?

What kinds of experiences and/or education have you had that you think would help you in your role as Satir Coach and Mentor?:

Are you certified in any other coaching methodologies? If so, please list below.

Please share a little about the personal growth work you have done.

Have you had in-person Satir Training?

Yes

With whom?

How many hours?

Please confirm that you are able to travel to Chapel Hill, NC for the 5 required in-person training sessions.

Yes, I am able to travel to Chapel Hill for in-person session.

No. I cannot guarantee that I can travel to Chapel Hill.