Coaching Course Intake Form

Please answer as honestly as you can so we can serve you better. All information will be kept confidential. We never share or sell your information.

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About You

Please list education (university degree, certificates, coaching training) *

Please list any experience related to coaching divorce, alienation or related topics: *

Please list any experience related to coaching or counseling in other topics: *

Do you have personal experience with alienation or estranged relationships? If so please describe it in less than 500 words.

What did you learn from that experience?

Why do you want to be a coach with Reversing Parental Alienation? *

In your own words, why do you think the methodology used by RPA is effective? *

What would you personally bring as a coach? *

Please check all that apply to you:

I am an adult child of alienation who reunited

I am an alienated parent who reunited with all of my alienated children

I am an alienated parent who reunited with some of my alienated children

I am an alienated parent who reunited with none of my alienated children

I am experiencing alienation right now

I experienced alienation as a step-parent or other family member

I reunited as a student or client of Ginger’s (I paid to enroll in one of her programs)

I am a lawyer

I am a coach

I am psychologist or social worker

I am a meditator

Background Information

Have you ever been arrested? *

Yes

Do you have any past or active restraining orders against you? *

Yes

Did you suffer from addiction? *

Yes

Have you been diagnosed with any mental disorder?

List any therapy, support groups or coaching you are currently doing. *

We encourage all coaches who work with us to work with their own coach, therapist or counselor

Are you familiar with Ginger’s work?

I watched Erasing Family Documentary

I watched but didn’t finish the Erasing Family Documentary

I took the Roadmap Course

I worked with Ginger one on one

I worked with Ginger in group coaching

I read took the free trainings such as webinars, challenges, ebooks

I follow her regularly on Facebook Erasing Family

I follow her regularly on Instagram Erasing Family

I follow her regularly on Youtube Erasing Family

I’ve seen her podcasts or TV appearances

I received an email

Recommended by/Other (specify below)

Were you recommended by anyone or any other way you found Ginger? *

If accepted into the coach training program, I can commit to _______ hours a week to review material (videos, read articles) on my own? *

If accepted into the coach training program, I can commit to _______ hours a week of live trainings per week? *

If accepted into the coach training program, I can commit to _______ hours a week to practice coaching sessions? *

If I graduate the coaching program, I am interested in the following (Check all that apply) *

Working with moms one on one

Working with dads one on one

Working with (adult) kids one on one

Working with other family members one on one

Working in group settings with multiple people

I want to work under the RPA company (we find clients, you coach)

I want to work on my own with a certification

This would ideally supplement my other work

This ideally would be full time for me or my main source of income

Being an ambassador for RPA (going to in person events)

Being an ambassador for RPA (hosting virtual events, such as Facebook lives, or recording reels)

Helping to get more clients via phone calls, direct messages and marketing (for a commission)

Do you have a financial or professional goal to train with us? (we are a business, so don’t be shy about this goal!) *

What are your fears about being a coach? *

What do you think are your biggest obstacles to finishing the program? *

What are the most valuable skills you bring to coaching alienated parents? *

Anything else we should know?

Check which plan you want to use: *

Professionals $5000

For reunited parents $2500

For reunited parents $1000 plus 20% royalty on all outside clients coached on topics related to divorce, alienation, estrangement. NOTE: you don’t pay royalties on clients we assign to you directly.

For reunited (now adult children) $500

OR $100 plus 20% royalty on all outside clients coached on topics related to divorce, alienation, estrangement. NOTE: you don’t pay royalties on clients we assign to you directly.

I find all these options a bit scary! I didn't realize I would have to pay. Please reach out to me to discuss options to start now or in the future.

Check one box: *

I can pay the amount in full

I need a payment plan

I need additional financial help

I am a professional but prefer a royalty deal