First Name *

Last Name *

Email *

Phone *

LinkedIn URL (Optional)

1. What best describes your current role? (Select one) *

Executive (C-suite, EVP, SVP)

Senior Leader (Director, VP, Head of Department)

Manager or Team Lead

Founder or Business Owner

Other

2. Which best describes the organization you lead or work within? *

Corporate / Enterprise

Small to mid-sized company

Nonprofit or mission-driven organization

Startup

Independent / Consulting / Solo practice

3. Approximately how many people do you directly or indirectly influence in your role? *

1–5

6–15

16–50

51–200

200+

4. Executive coaching requires reflection, honesty, and follow-through. How ready are you to engage fully in this process? *

Fully ready and committed

Ready, with some competing priorities

Exploring but unsure about timing

5. BW Empowerment Executive Coaching is a paid, premium engagement designed for leaders who are ready to invest $1500 towards their growth. *

I understand this is a paid executive coaching engagement and I am prepared to invest if accepted.

I am interested but would need to discuss timing or payment options.

I am exploring only and not ready to invest at this time.

6. The upcoming cohort begins on: February 18th, 2026 - Please confirm your availability: *

Yes, I am available and able to participate

I am interested but may need a future cohort

7. How did you hear about BW Empowerment Executive Coaching? *

Referral

Speaking engagement or event

Email or newsletter

Website

Social Media (Linkedin, Instagram, Facebook, TikTok, Etc.)

Other

Very Important!

I understand that submission of this application does not guarantee acceptance.

I understand this is a paid executive coaching engagement.

SUBMIT