Coaching Form Design Coaching Information Form This form is designed to gather background information to better understand your coaching needs and create an effective, tailored approach. Some personal information is collected but will only be used to create anonymous profiles for analysis and planning purposes. No payment is involved—this is purely for information gathering. Estimated Completion Time: 10–15 minutesFor questions or concerns, please contact us at sales@koalescedesigns.com.PreviousNextSection 1: Demographic InformationThis section helps us understand who you are and your general background. It includes basic details like your location, age group, and education level to create anonymous profiles for analysis.Your NameCountry- Select -AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsState- Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificWhat is your time zone?- Select -(GMT -10-00) Hawaii(GMT -9-00) Alaska(GMT -8-00) Pacific Time (US & Canada)(GMT -7-00) Mountain Time (US & Canada)(GMT -6-00) Central Time (US & Canada), Mexico City(GMT -5-00) Eastern Time (US & Canada), Bogota, LimaWhat is your age?- Select -Under 1818-2425-3435-4445-5455-6465 or AbovePrefer Not to AnswerWhat gender do you identify as?- Select -AgenderCisgenderDemigenderWomanManNon-BinaryTransgender WomanTransgender ManIntersexPrefer Not to AnswerWhat are your preferred pronouns?- Select -She, her, hersHe, him, hisThey, them, theirsZe, hir, hirsZe, zir, zirsPrefer not to answerNo Pronouns, use my nameAre you Hispanic, Latino, or Spanish Origin? Yes NoHow would you describe your ethnicity? - Select -American Indian or Alaska NativeBlack or African AmericanEast Asian (e.g., Chinese, Korean, Japanese)Latino/a/x or HispanicTwo or More RacesNative Hawaiian or Other Pacific IslanderOther AsianOther (please specify)South Asian (e.g., Indian, Pakistani, Bangladeshi)Southeast Asian (e.g., Vietnamese, Filipino, Thai)WhitePrefer not to sayPlease specify your racial or ethnic identity:What is the highest level of school you have completed or the highest degree you have received?- Select -High SchoolTrade SchoolAssociate DegreeBachelor's DegreeGraduate or Professional Degree1-year College (No Degree)2-years College (No Degree)3-years College (No Degree)Ph.D. or higherOtherPrefer Not to AnswerWhat is your current marital or relationship status?- Select -SingleSingle with Child(ren)Single with Pet(s)DivorcedSeparatedMarriedMarried with a childMarried with 2 childrenMarried with 3 childrenWidowedLiving with Partner (Unmarried)It's ComplicatedPrefer not to sayWhat is your current employment status?- Select -Employed full-timeEmployed part-timeFreelance/ContractSelf-employedEntrepreneurUnemployed and seeking workUnemployed and not seeking workStay-at-home parentRetiredStudentOther (please specify)Employment: Other (please specify)What is your annual income range?- Select -Less than $25,000$25,000–$50,000$50,001–$75,000$75,001–$100,000$100,001–$150,000More than $150,000Prefer not to sayPreviousNextSection 2: Background InformationHere, we’ll gather insights about your professional journey, including your current role, experience level, and familiarity with design tools. This helps us understand where you are in your career and what foundational skills you might need.What is your current role?Are you transitioning into a career in design? Yes NoIf yes, how are you pursuing your transition?- Select -Are you currently enrolled in a bootcamp? (E.g., UX Design Bootcamps)Are you self-taught? (Using resources like YouTube, books, etc.)How many years of professional experience do you have?- Select -Less than 1 year1 year2–3 years4–6 years7–9 years10+ yearsWhat industries or fields have you worked in?What design tools have you used in your work?FigmaAdobe XDSketchAxure RPInVisionBalsamiqLookbackUserTestingOptimal WorkshopDovetailHotjarMazeUsabilityHubEthnioMiroFigJamNotionAirtableSlackZeplinStarkColorOracleWAVEAxe Accessibility CheckerLighthouseWould you like to share a brief summary of your professional journey?Design Portfolio URLWould you like to upload your résumé? (Optional)Upload your résumé here PreviousNextSection 3: Reasons for Seeking CoachingThis section focuses on your goals and motivations for seeking coaching. You’ll choose a primary and secondary focus area and describe what you aim to achieve through this experience.What are your main reasons for seeking coaching?Career DevelopmentSkills EnhancementLeadership and ManagementProject and Process ImprovementPersonal Design GrowthSpecialized Areas (see question below)Specialized Areas:- Select -AccessibilityService DesignInstructional DesignData VisualizationAI IntegrationOther (please specify)Other (please specify)In your own words, what do you hope to achieve through coaching?PreviousNextSection 4: Help AreasIn this section, we dive deeper into the specific areas where you want support. Your answers will guide the coaching sessions to focus on what’s most relevant to you.What specific career goals are you working toward?Find my first UX/Product Design jobTransition to a senior/leadership roleBuild a stronger portfolioSkill development (e.g., new tools, methods, or practices)Career guidance (e.g., navigating career paths, setting goals)Portfolio review (e.g., feedback, improvement, curation)Staying current with industry trendsImproving problem-solving skills in design contextsStrengthening user-centered thinking and practicesLearning project management in design contextsEnhancing team collaboration and communicationDeepening usability testing expertiseExpanding research methods (e.g., qualitative, quantitative)Developing design strategy (e.g., long-term planning, innovation)Other (please specify)Specialized Areas: What accessibility challenges are you currently facing?- Select -Lack of understanding of WCAG standardsDifficulty implementing accessible designsOther (please specify)Other (please specify):PreviousNextSection 5: LogisticsHere, we’ll cover practical details, such as your preferred session format, frequency, and availability. This ensures we can offer coaching that fits into your schedule.What is your preferred coaching session format?- Select -One-on-OneGroup CoachingWhat is your preferred session length?- Select -30 minutes60 minutesHow often would you like to have coaching sessions?- Select -Every dayOnce a week2 to 3 times a weekOnce a month2 to 3 times a monthOne-time sessionLess than once a monthWhat is your preferred contact method for coaching sessions?- Select -EmailPhone (e.g., FaceTime)Web conference (e.g., Zoom, Google Meet)Phone/MobileEmailWhat are the best days and times for your coaching sessions?Days of the weekSundayMondayTuesdayWednesdayThursdayFridaySaturdayTimes- Select -MorningsAfternoonsEveningsAre you currently part of an accelerator, mentorship program, or similar initiative? Yes NoIf yes, which program are you a part of?Tech HustleRussell Innovation Center for EntrepreneursGoodie NationAtlanta Black Chambers Previous Submit Your Information
