Volunteer Coaches Application
for the Gary S. Stevens Foundation, (GSSF) doing business as Life's Headwaters.
A 501c3 not for profit private operating foundation.
Pardon our dust as we transition our websites!!!
Thank you for your interest in coaching men and women
to successfully navigate life transitions. We have an open request for coaches at all times.
After you hit submit on this form, please note the page you are brought to as it contains important instructions on
your next steps to complete the volunteer process!
Thank you again for your interest in assisting men and women throughout the United States.
If you would like to volunteer in another capacity, please use this form as well and note in the comments section your desires.
First Name:
Last Name:
Street Address:
City:
State:
Zip:
Telephone:
Alternate Telephone:
Fax:
WebSite (if applicable):
Are you an accredited
coaching school graduate:
Select One Yes No Pending
School Name:
Date of Graduation:
Hours coaching (paid):
Hours coaching (pro-bono):
Coaching niche(s):
Client type you'd like to coach:
Select One 18 - 24 year old 25+ year old Anyone 18 years of age and above
Select One One to One Coaching - Phone One to One Coaching - In Person Tele-seminars Group Phone Coaching Workshop - In Person Internet - Email or Chat Coaching Speaker Other not listed
You may select as many as you wish by holding down your control key and highlighting each selection
Member of ICF:
Yes No
Member of IAC:
Professional Certification Level:
Select One None Coaching School Graduate Pending PCC ACC MCC Other, please list in box below
Highest Level of Education Completed:
Select One High School Graduate AA/AS BA/BS Vocational Certificate Professional Degree MBA/MSW/MA/JD/PhD Other not listed
Ever been convicted of a felony or pending trial on one:
Select one No Yes
Time Zone you live in:
Select One P - Pacific A - Arizona C - Central E - Eastern O - Other not listed
Do you agree to a criminal background
check if necessary to work with clients?
Select One Yes No Let's talk
Do you agree to abide by the
ICF Code of Ethics for Coaches?
Describe your ideal volunteer coaching focus or assignment:
( tele-seminar class leaders for training other coaches are requested as well)
(roughly 125 words or less)
Please offer a statement about what you want to accomplish or will gain by volunteering to coach with GSSF and it's programs/clients?
(roughly 400 words or less)
If you want a record of your application,
please print your screen before you submit your information.
