COVER-PRO
SM
APPLICATION
CAREER COACH SUPPLEMENT
1. Full name of the Applicant Firm:
2. Please indicate which credentials the Applicant holds:
Associate Certified Coach / ACC
Professional Certified Coach / PCC
Master Certified Coach / MCC
If you are credentialed from an ICF approved school, please indicate the name of the school:
4. Please indicate the percentage of the Applicant’s annual revenue from the last fiscal period involving:
A) Executive Coaching:
Career planning: %
Communication skills: %
Leadership skills: %
Networking: %
TOTAL:
%
B) Career
Coaching
Career planning: %
Communication skills: %
Leadership skills: %
Networking: %
TOTAL:
%
C) Perso
nal Coaching:
Resume / Cover letter writing: %
Financial information & planning: %
Interview coaching: %
Life coaching: %
TOTAL:
%
D)
Other (specify):
: %
: %
: %
: %
TOTAL:
100 %
A + B +
C + D (MUST EQUAL 100%)
I understand that the information submitted herein becomes a part of my Philadelphia Insurance
Companie
s Cover-Pro
sm
application and is subject to the same conditions as stated on the application.
Name (Please Print) Title (Must be Principal, Partner or Officer
)
__________________________________________
Signature Date
PI-PSLP-CCSUPP 08/
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