Welcome Form

Please fill out this brief questionnaire. 

This information will help us to support you in accomplishing your DISC Certification objectives.

Welcome Form

Full Name

(F. Name  L. Name; John Doe)

Primary E-Mail

Primary Phone Number

Format (555-555-5555)

Time Zone

AST ATLANTIC STANDARD TIME UTC - 4
EST EASTERN STANDARD TIME UTC - 5
EDT EASTERN DAYLIGHT TIME UTC - 4
CST CENTRAL STANDARD TIME UTC - 6
CDT CENTRAL DAYLIGHT TIME UTC - 5
MST MOUNTAIN STANDARD TIME UTC - 7
MDT MOUNTAIN DAYLIGHT TIME UTC - 6
PST PACIFIC STANDARD TIME UTC - 8
PDT PACIFIC DAYLIGHT TIME UTC - 7
AKST ALASKA TIME UTC - 9
AKDT ALASKA DAYLIGHT TIME UTC - 8
HST HAWAII STANDARD TIME UTC - 10
HAST HAWAII-ALEUTIAN STANDARD TIME UTC - 10
HADT HAWAII-ALEUTIAN DAYLIGHT TIME UTC - 9
SST SAMOA STANDARD TIME UTC - 11
SDT SAMOA DAYLIGHT TIME UTC - 10
CHST CHAMORRO STANDARD TIME UTC +10

Company / Organization

Job Title/ Position

Address

Street Address

City, State, Zip

How many years of experience do you have in coaching?

  • 1 yr. - 3 yrs.
  • 4 yrs. - 6 yrs.
  • 7 yrs. - 9 yrs.
  • 10 yrs. - 12 yrs.
  • 12 yrs. plus

How many years of experience do you have in coaching?

  • 1 yr. - 3 yrs.
  • 4 yrs. - 6 yrs.
  • 7 yrs. - 9 yrs.
  • 10 yrs. - 12 yrs.
  • 12 yrs. plus

How many years of experience do you have in human resources?

  • 1 yr. - 3 yrs.
  • 4 yrs. - 6 yrs.
  • 7 yrs. - 9 yrs.
  • 10 yrs. - 12 yrs.
  • 12 yrs. plus

How many years of experience do you have in training?

  • 1 yr. - 3 yrs.
  • 4 yrs. - 6 yrs.
  • 7 yrs. - 9 yrs.
  • 10 yrs. - 12 yrs.
  • 12 yrs. plus

How did you hear about DISCcert?

(Examples: Google, friend, colleague, DISC Tips - Newsletter, other)

Do you currently have training-oriented responsibilities within your organization?

If yes, please briefly describe what those responsibilities consist of.

Do you have prior positions that have had training - related assignments?

If yes, please briefly describe what those assignments consisted of.

Educational Background

(Degrees? Certificates?)

Have you previously used DISC In A training program or coaching session?

If yes, please elaborate below.

What does becoming DISC certified mean to you?

Please briefly explain your personal feelings towards being DISC certified.

Summary

Thank You!

This information will help us to support you in accomplishing your DISC Certification Objectives. Please continue on your journey to Step #2.