Application ADC Student (2022)

2025 Associate Diversity Coach

Attend Session 1 + Virtual Practicum = 60 hours

Tuition $6,897 + Application Fee $100 non-refundable

Practicum Hours Include: Virtual Labs, Writing Assignment, Peer and Mentor Coaching

Upon acceptance into the program, your initial payment of $2,897 is due.
Training Program*

Associate Diversity Coach
Select Location*

Virtual (Zoom)
Virtual Dates (Zoom)*

Aug 20-22, 2025
Name*

PrefixFirst NameLast Name
Email*
If you decide to purchase a hard copy of the workbook, we will send you the workbook one week before class starts. Please provide the best address for you to receive a package.
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone*

Area CodePhone Number
Pronouns*

He / Him / His.She / Her / Hers.They / Them / Theirs.Other
Which of the following best represents your race or ethnic heritage?*

WhiteBlack, Afro-Caribbean or African-AmericanLatino or HispanicAsian or Pacific IslanderMiddle Eastern or ArabNative American or Alaskan NativeOther
Highest Level of Education Completed*
Which of the following best represents your religious affiliation?*

BuddhistCatholicChristian (non-specific)HinduJewishMormonMuslimProtestantSikhNon-Christian FaithNoneNo AnswerOther
Work History*

0/1000
Why Did You Choose CoachDiversity Institute?*

0/1000
Briefly tell us why you want to be a certified coach.*

0/1000
How do you rate yourself in the following areas:

Self-awareness*

	1	2	3	4	5

1 is Worst, 5 is Best

Active Listening*

	1	2	3	4	5

1 is Worst, 5 is Best

Emotional Intelligence*

	1	2	3	4	5

1 is Worst, 5 is Best

Being Non-judgmental*

	1	2	3	4	5

1 is Worst, 5 is Best

Openness to Learning New Things*

	1	2	3	4	5

1 is Worst, 5 is Best

How do you hope to grow through the program?*

0/1000
Describe your current professional and career goals*

I want to start my own coaching practice.I want to become an internal coach at an organization.I want to enhance my professional development.I want to use coaching skills in my therapy / counseling practice.Other
Who referred you?*

Application Fee$100.00

OPTION: Workbook (hard copy)$30.00

Virtual students can receive a hard copy of the workbook by mail.

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