Coach Certification Program Application 2026

Please fill out the form below to apply for our Coach Certification Program.

Applications must be completed online in one sitting. The system will not save partially completed applications.

CCP Application 2026

First Name

Last Name

Preferred Name

What Is your gender?

Female Male Non-binary/third gender Prefer not to say

Title / Position

Upload Your Bio (accepted files types: pdf, doc, or docx)

Which city do you live in?

Country

Phone Number

Company / Organization

Company / Organization Website

Have you completed a three-day Minds at Work Facilitator's Workshop or a five-week Immunity to Change™ for 1:1 Coaching: Maps and Tests Workshop?

Yes No

Proficiency in spoken and written English is essential for participation in the Coach Certification Program.

I affirm that I am proficient in spoken and written English.

If not English, in what language do you anticipate you will be using with the majority of your prospective Immunity to Change™ clients?

If Other was selected please specify the language you'll use.

How did you learn about this program?

If Other, please describe how you learned about this program.

What function best describes your position?

If Other, please specify

Please select your primary field/industry:

If Other, please specify

Provide a brief description of your organization:

Please describe your current responsibilities:

What factor has most influenced your decision to apply to this program? Why does the Immunity to Change Coach Certification Program appeal to you at this point in your career? How do you envision using ITC?

Please explain your objectives and goals as they relate to attending this program. Also describe what you think other program participants may learn from you (e.g. perspectives, skills, expertise):

Who are your primary coaching clients (individuals, teams, level in organization, etc.)?

Do you have an adaptive (not technical) personal Improvement Goal that is of high interest and importance to you? This may or may not be related to your being an even more effective coach / change practitioner. Most important is that the goal is important to you!

Do you have a potential “practice client” in mind that could be a case study for your learning during the program? (The practice client is not a paying client.)

Yes No

Please check below if you:

Are applying with multiple people from the same organization. work exclusively in the non-profit sector.

Coach Certification Program Application 2026

Please fill out the form below to apply for our Coach Certification Program.

CCP Application 2026

office@mindsatwork.com

(617)-491-2656

PO Box 1386 Raymond, NH 03077