Welcome to our program application, your first step to becoming a Professional Performing Edge Coach. Please complete the application below for consideration of acceptance into the Performing Edge Coaching Professional (PECP) certification program. Completion of this application is used to identify qualified candidates. Applicants will be notified of acceptance into the program and then will be asked to complete the enrollment form for the program. If you have any questions, feel free to contact us at 650-654-5500.

Name

Address

Phone

Mobile

Fax

Email

Gender ---MaleFemale

Age

Current Profession

Current Job Position

Title

How did you hear about the PECI program?

Meeting time preference: What day and time do you prefer to meet via phone each week? Choose a DayMondayTuesdayWednesdayThursdayFridaySaturdaySunday, Choose a Time8:00 AM9:00 AM10:00 AM11:00 AMNoon1:00 PM2:00 PM3:00 PM4:00 PM5:00 PM6:00 PM7:00 PM8:00 PM (All times are PST)

Motivation for becoming a Performing Edge Coach - Please tell us why you would like to integrate coaching with athletes into your practice (use box below).

Background in Sports, Fitness or Health - Please provide a short history of your experiences in sports, fitness, or wellness as an athlete, coach, student, therapist or other disciplines (use box below).

Professional Qualifications
Please add your resume or background information (use box below).

Please list your membership in any professional organizations (e.g. APA or AAASP)

Have you ever attended or participated in any form of coaching, mental training or sports psychology programs? If so, where/when?

If accepted into the PECI program, when would you like to begin the course?

January 2011Spring 2011Summer 2011